atherosclerotic

Atherosclerotic describes a process and lesions associated with atherosclerosis, a chronic arterial disease characterized by the buildup of lipids, inflammatory cells, and connective tissue in the intima of arteries. These atherosclerotic changes can form plaques that narrow or occlude vessels and may lead to reduced blood flow or plaque rupture with thrombosis.

The pathogenesis involves endothelial dysfunction, accumulation of low-density lipoprotein in the intima, oxidative modification, and an inflammatory response. Smooth muscle cells migrate from the media to the intima and proliferate, forming a fibrous cap over a lipid-rich necrotic core. Calcification can occur within plaques. The process is influenced by risk factors such as aging, male sex, smoking, hypertension, high cholesterol, diabetes, obesity, and a positive family history.

Sites commonly affected include coronary arteries, carotid arteries, and peripheral arteries. Clinically, atherosclerotic disease can cause angina and myocardial infarction when coronary arteries are involved, cerebrovascular events like stroke when carotids are affected, and peripheral artery disease with claudication or critical limb ischemia. Plaque rupture can trigger thrombosis and acute events even without major luminal narrowing.

Diagnosis relies on clinical assessment and imaging, including duplex ultrasonography, computed tomography or magnetic resonance imaging, coronary angiography, and calcium scoring. Management emphasizes risk factor modification and secondary prevention: lipid-lowering therapy (such as statins), antiplatelet agents where indicated, control of blood pressure and glycemia, smoking cessation, and weight management. Revascularization procedures may be considered for obstructive disease.