Macroangiopathies

Macroangiopathy refers to disease of the large and medium-sized arteries, encompassing conditions such as atherosclerosis and calcific medial sclerosis. It affects major vascular beds, including coronary, carotid, cerebral, and peripheral arteries, and can lead to ischemic events and organ dysfunction. Macroangiopathy is distinct from microangiopathy, which involves small vessels like arterioles and capillaries.

Pathophysiology typically involves a combination of lipid accumulation, chronic inflammation, and smooth muscle proliferation within the intima, forming atheromatous plaques that can stenose or occlude vessels. In some arteries, especially in older individuals and those with diabetes or chronic kidney disease, calcific changes in the media (Monckeberg-type calcification) weaken and stiffen the vessel wall, contributing to reduced elasticity and altered hemodynamics. Both processes increase the risk of stenosis, occlusion, aneurysm formation, and thrombotic events.

Clinical manifestations depend on the affected vessels and may include coronary artery disease with angina or myocardial infarction, carotid or intracerebral disease with stroke, and peripheral arterial disease presenting as claudication or critical limb ischemia. Some patients remain asymptomatic until an event occurs.

Diagnosis relies on risk factor assessment and imaging such as duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, and conventional angiography to identify stenoses, plaques, or aneurysms. Laboratory tests focus on cardiovascular risk factors (lipids, glucose, blood pressure, smoking status).

Management emphasizes risk factor modification, statin therapy, antiplatelet agents, antihypertensives, and glycemic control as appropriate. Revascularization via endovascular interventions or surgery may be indicated for significant or symptomatic disease. The prognosis is closely linked to the extent of vascular involvement and control of underlying risk factors.