Fibroatheromatöse

Fibroatheromatöse (fibroatheromain, fibroatheromatosis) is a term used to describe an advanced stage of atherosclerotic disease in which a lipid-rich necrotic core is covered by a relatively thin fibrous cap, forming what is commonly called a fibroatheroma. This plaque type is characterized by a combination of lipid accumulation, inflammatory cells, a necrotic core, and a fibrous cap that may become weakened or eroded.

Pathophysiology and morphology

In fibroatheromatous lesions, foam cells and other inflammatory cells populate the intima, creating a sizable necrotic core. The fibrous cap, composed of smooth muscle cells and collagen, can thin due to enzymatic degradation by macrophages and inflammatory mediators. Mechanical stress, lipid leakage, and microvascular bleeding within the plaque can further destabilize the cap, increasing the risk of rupture or erosion.

Clinical significance

Fibroatheromatous plaques are central to the pathogenesis of acute coronary syndromes and ischemic strokes. Rupture or erosion exposes tissue factor and thrombogenic material to the bloodstream, triggering thrombus formation and possible vessel occlusion. Plaque instability is influenced by risk factors such as hyperlipidemia, hypertension, smoking, diabetes, and systemic inflammation.

Diagnosis and imaging

Diagnosis relies on clinical assessment and imaging to assess plaque composition and stability. Intravascular ultrasound and optical coherence tomography can visualize cap thickness and lipid cores. Magnetic resonance imaging and computed tomography may provide noninvasive information about plaque burden and composition. Histology remains the reference standard for defining plaque characteristics.

Management and prognosis

Treatment focuses on risk factor modification (lipid lowering, blood pressure control, glycemic management), antiplatelet therapy, and agents that stabilize or regress atherosclerosis (notably statins and, when indicated, PCSK9 inhibitors). In some cases, revascularization or endarterectomy may be necessary. The prognosis depends on plaque stability and the effectiveness of risk reduction strategies.