| Abstract: | In summary, the sequence of endothelial plaque disruption, platelet activation, and thrombogenic factors--that is, the balance between the thrombolytic system and the coagulation system--determine which blood vessel will thrombose and which vessel will remain patent. It seems to me that although the soft plaque with the thin cap and lipid core laden with oxidized LDL-activated macrophages is more prone to rupture than the calcified, hard plaque, it is also the plaque that may regress when the patient is treated aggressively with lipid-lowering or antioxidant therapy. In addition, drugs that lower blood pressure and heart rate may also decrease the tendency of the "vulnerable" plaque to rupture by attenuating fatigue failure. Current and future research should be directed at identifying vulnerable plaques in the individual patient, so that measures can be taken to prevent plaque rupture. |
