Hamana Tomoyo, Shah Palak, Grogan Alyssa, Kawakami Rika, Williams Desiree, Diaz Keisha Medina, Virmani Renu, Finn Aloke V
CVPath Institute, Inc, 19 Firstfield Road, Gaithersburg, MD, 20878, USA.
School of Medicine, University of Maryland, Baltimore, MD, USA.
Curr Atheroscler Rep. 2024 Dec 11;27(1):17. doi: 10.1007/s11883-024-01262-y.
Plaque erosion is the second leading cause of coronary thrombosis following plaque rupture and represents a key pathophysiological process underlying acute coronary syndromes that can culminate in sudden coronary death. While the precise mechanisms and risk factors driving plaque rupture are well-established, those for erosion have only recently been explored. This review summarizes current literature on the characteristics and risk factors favoring plaque erosion.
Plaque erosion is characterized by a defective endothelial layer in the intima, promoting thrombus formation in the presence of an intact fibrous cap. It is more common in younger women (< 50 years) and smokers. Pathologic intimal thickening or fibroatheroma are common underlying lesions. Risk factors include gender, age, smoking, and disturbances in shear flow. Advances in pathogenic and molecular mechanisms, such as endothelial shear stress, neutrophil activation, and toll-like receptor-2 pathways, are discussed. Understanding the major risk factors for plaque erosion can inform diagnostics and therapeutics to prevent the progression of arterial thrombosis.
斑块侵蚀是继斑块破裂后导致冠状动脉血栓形成的第二大原因，是急性冠状动脉综合征潜在的关键病理生理过程，最终可能导致心源性猝死。虽然导致斑块破裂的确切机制和危险因素已得到充分证实，但斑块侵蚀的机制直到最近才被探索。本综述总结了目前关于有利于斑块侵蚀的特征和危险因素的文献。
斑块侵蚀的特征是内膜内皮细胞层存在缺陷，在纤维帽完整的情况下促进血栓形成。它在年轻女性（<50岁）和吸烟者中更为常见。病理性内膜增厚或纤维粥样瘤是常见的潜在病变。危险因素包括性别、年龄、吸烟和剪切流紊乱。本文还讨论了致病和分子机制方面的进展，如内皮剪切应力、中性粒细胞活化和Toll样受体2途径。了解斑块侵蚀的主要危险因素有助于指导诊断和治疗，以预防动脉血栓形成的进展。
