From the Guidelines
A stroke caused by atherosclerotic plaque is primarily due to the rupture of the plaque, which forms a clot that blocks blood flow to the brain, and is often the result of a combination of factors including high cholesterol, hypertension, and inflammation in the vascular wall. The cause of a stroke due to atherosclerotic plaque is multifactorial, involving the buildup of fatty deposits in blood vessels, which can eventually rupture and form a clot that travels to smaller vessels in the brain, cutting off oxygen and nutrients to brain tissue 1.
Key Factors Contributing to Atherosclerotic Plaque Formation
- High cholesterol: contributes to the buildup of fatty deposits in blood vessels
- Hypertension: increases the risk of plaque rupture and clot formation
- Inflammation in the vascular wall: destabilizes the endothelial cell layer and increases oxidative stress
- Diabetes: increases the risk of ischemic stroke, but the optimal management of blood glucose homeostasis to prevent stroke is not well established 1
- Lack of regular exercise: may increase the risk of stroke, but the independent effect of exercise on stroke risk is not clear 1
Prevention and Treatment
- Statins such as atorvastatin or rosuvastatin are crucial for reducing plaque formation by lowering cholesterol and stabilizing the endothelial cell layer 1
- Antiplatelet medications like aspirin or clopidogrel may be prescribed to prevent clot formation
- Blood pressure control with medications like ACE inhibitors or ARBs is essential, targeting levels below 130/80 mmHg
- Lifestyle modifications including a Mediterranean diet, regular exercise, smoking cessation, and limiting alcohol consumption can significantly reduce stroke risk by addressing the underlying causes of plaque formation 1
From the Research
Causes of Stroke due to Atherosclerotic Plaque
- Atherosclerotic plaque rupture and superimposed thrombus formation is the cause of 70% to 80% of ischemic strokes 2
- Large artery athero-thromboembolism is a major cause of ischemic strokes, accounting for approximately 85% of all strokes 3
- Carotid atherosclerotic plaque is a leading cause of mortality and disability worldwide, associated with approximately 15%-20% of ischemic stroke cases 4
Mechanisms of Stroke due to Atherosclerotic Plaque
- The formation of a thrombus on top of a ruptured atherosclerotic plaque can lead to ischemic stroke 2
- The rupture of an atherosclerotic plaque can cause a sudden blockage of a blood vessel, resulting in ischemic stroke 3
- The development of carotid artery stenosis is a risk factor for ischemic stroke, and can be caused by a combination of factors including hypertension, diabetes, and high cholesterol 4
Risk Factors for Stroke due to Atherosclerotic Plaque
- Hypertension is a major risk factor for stroke, and can contribute to the development of atherosclerotic plaque 3
- Diabetes and high cholesterol are also risk factors for the development of carotid artery stenosis and ischemic stroke 4
- Age and family history can also play a role in the development of atherosclerotic plaque and ischemic stroke 3