Prospective lesion formation in carotid arteries

Abstract

Atherosclerosis develops from the accumulation of oxidized LDL. As the damage increases a plaque is formed in the artery wall. The location of plaque development is usually at bifurcations, branches and bends as these sites have altered shear stress levels. High shear stress levels are associated with an atheroprotective phenotype as the oxLDL and monocytes have less contact with the artery wall. High shear stress levels are associated with less pro-inflammatory transcripts and increase NO production. Low shear stress levels are associated with endothelial dysfunction as the oxLDL and monocytes have more contact with the artery wall. The treatment of carotid artery lesions had been entirely surgical until the advent of balloon angioplasty. Balloon angioplasty gave practitioners another treatment option. Also a combination of balloon angioplasty and surgery is possible for the difficult carotid plaques. The besy way to treat carotid artery stenosis is to perform surgery rather than angioplasty as surgery is more effective and durable and angioplasty with stent placement is associated with a higher risk of restenosis. But for patients that can tolerate surgery angioplasty is a good alternative. When angioplasty is performed it is best to use selective stent placement. For treatment of the common carotid artery stenosis surgery is an effective and durable treatment. But the hybrid procedure provides a less invasive treatment. Comparing both approaches for the treatment of common carotid stenosis only a few studies are published.But as there are only a few studies published a conclusion of which is the best way to treat common carotid stenosis cannot be made. In the future more studies must be performed to elucidate whether the hybrid procedure is the best way to treat common carotid stenosis.