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Common Carotid Arteries
Plaque?PBL 8
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(IMT via CarotidUltrasonography)
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CCA(Common Carotid Artery)
CommonCarotid Artery
ExternalCarotidInternal
Carotid
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CCA(Common Carotid Artery)
Common Carotid: blood supply to headand neck. RT and LT
External carotid: the exterior of the head, theface, and the
greater part of the neck
Internal carotid: the parts inside the cranialand orbital
cavities
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Genesis of Plaque
LDL accumulates in inthe intima
LDL associates withextracellular matrix:proteoglycans
LDLs are separated fromplasma antioxidants;oxidative
modification
Inflammatory response:phagocytes ingest lipidand become foam
cells
Smooth-muscle cellsmigrate
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Prognosis of AtheroscleroticPlaque
Plaque Development
Prognosis
Myocardial infarct
Cerebral infarct Gangrene of
Extremities
Abdominal aortic
aneurysm
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Prognosis of AtheroscleroticPlaque
Release cytokines andgrowth factors
Producing smoothmuscle and
extracellular matrix Plaque instability and
rupture; contactthrombogenic collagenand tissue factor
markers ofinflammatoryactivation
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Prognosis of AtheroscleroticPlaque
Stroke
Ischemic Heart
Disease Peripheral vascular
disease
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Risk Factor
LDL
Cigarette smoking TF
Hypertension Low HDL cholesterol
Diabetes mellitus
Family History of
premature CHD Age
Lifestyle factors Obesity
Physical Inactivity
Atherogenic diet
Emerging Risk Factor Lipoprotein
Homocysteine
Prothrombotic Factors
Impaired fastingglucose
Subclinicalatherogenesis
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Plaque Development andMetabolic Syndrome
metabolic syndromevs. control subjects
51 vs. 35% plaques
34 vs. 19% carotidstenosis > 40%
8 vs. 3% increased
incidence of CHD
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Plaque Development andMetabolic Syndrome
FFA fromAdipose cells
Liver releasesGlc, TAG, VLDL
Decrease ofHDL
Small DenseLDL
Cholesterol-richVLDL
Hypertension
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Diagnosis
Plaque Carotid Ultrasonography, CT, MRI, Angiography
Homocysteine
CRP and other inflammatory molecules Lipoprotein
HDL
LDL Lifestyle
Obesity, Smoking, etc.
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Diagnosis-Risk Factor
LDL
Cigarette smoking TF
Hypertension Low HDL cholesterol
Diabetes mellitus
Family History of
premature CHD Age
Lifestyle factors Obesity
Physical Inactivity
Atherogenic diet
Emerging Risk Factor Lipoprotein
Homocysteine
Prothrombotic Factors
Impaired fastingglucose
Subclinicalatherogenesis
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Therapy
Risk Category LDL Level (mg/dL) Goal
Very High
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Therapy
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Therapy
Quit Smoking
Exercising regularly
Aspirin
Diet Change
3
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Reference
Fauci. Braunwald. Kasper. Hauser. Longo.Jameson. Loscalzo.
Harrisons Principles ofInternal Medicine, 17th Edition.
McGraw-Hills.
Enzo Bonora, Stefan Kiechl, Johann Willeit,Friedrich
Oberhollenzer, Georg Egger,Riccardo C. Bonadonna, Michele
Mugge.Carotid Atherosclerosis and Coronary Heart
Disease in the Metabolic Syndrome.Diabetes Care, Volume 26,
Number 4, APRIL2003
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Reference
ALLENP. BURKE, M.D., ANDREWFARB, M.D.,GRAYT. MALCOM, PH.D.,
YOU-HUILIANG,M.D., JOHNSMIALEK,M.D.,ANDRENUVIRMANI, M.D.,
CORONARY
RISK FACTORS AND PLAQUEMORPHOLOGY IN MEN WITH CORONARYDISEASE
WHO DIED SUDDENLY. The NewEngland Journal of Medicine. 1997
Human
Anatomy:http://www.theodora.com/anatomy/the_common_carotid_artery.html
