Atherothrombosis and ischaemic stroke

doi:10.1136/bmj.38964.489051.80

BMJ 2007;334:379-380 (24 February), doi:10.1136/bmj.38964.489051.80

Editorials

Atherothrombosis and ischaemic stroke

Unstable plaque is the main mechanism of stroke in patientswith carotid stenosis

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Thrombosis due to "unstable" atherosclerotic plaque is the mainmechanism underlying acute coronary syndromes, and vascularresearch has focused mostly on this model. Plaque also causesa substantial proportion of ischaemic stroke, although multiplemechanisms are involved and "stable" plaque is sometimes responsible.For example, in the basilar and proximal middle cerebral arteries,stroke can result from occlusion of a small branch vessel byslow growth of otherwise "stable" plaque in the parent vessel.Slowly growing but stable plaque can also cause cerebral ischaemiadue to stenosis and hypoperfusion without thromboembolism. Recentevidence, however, suggests that the predominant mechanism ofstroke, at least in patients with carotid stenosis, is similarto the coronary model and involves mainly unstable plaque.¹²³This observation has implications for the way we manage andprevent strokes.

Carotid plaques are typically slow growing or quiescent forlong periods but may suddenly develop ruptures, fissures, orendothelial . . . [Full text of this article]

P M Rothwell, director, stroke prevention research unit

Radcliffe Infirmary, University of Oxford, Oxford OX2 6HE

peter.rothwell@clneuro.ox.ac.uk

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