Unstable plaque

Unstable Plaque

An Unstable Plaque is a type of atherosclerotic plaque that can lead to acute coronary events such as myocardial infarction (heart attack) or stroke. These plaques are characterized by a thin fibrous cap, a large lipid core, and increased inflammatory cell activity.

Pathophysiology

The pathophysiology of unstable plaque involves several processes. The plaque begins as a fatty streak in the arterial wall, which is an accumulation of lipoprotein particles. Over time, these particles become oxidized and attract monocytes, which differentiate into macrophages. These macrophages ingest the oxidized lipoproteins, becoming foam cells and contributing to the formation of the lipid core.

The fibrous cap is formed by smooth muscle cells that migrate from the media of the artery to the intima, where they proliferate and produce extracellular matrix proteins. However, in unstable plaques, this cap is thin and prone to rupture due to the activity of matrix metalloproteinases produced by the inflammatory cells.

Clinical Significance

Unstable plaques are clinically significant because they can lead to acute coronary events. When the fibrous cap ruptures, the lipid core is exposed to the blood, leading to the formation of a thrombus. This thrombus can occlude the artery, leading to ischemia and tissue death.

Diagnosis

Diagnosis of unstable plaque can be challenging, as they often do not cause symptoms until rupture. However, imaging techniques such as intravascular ultrasound and optical coherence tomography can be used to visualize the plaque and assess its stability.

Treatment

Treatment of unstable plaque involves both medical and surgical interventions. Medical treatment includes antiplatelet therapy, statins, and beta blockers. Surgical interventions may include angioplasty or coronary artery bypass grafting.

See Also

• Atherosclerosis
• Coronary artery disease
• Acute coronary syndrome

References

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