Normal Artery

Normal Artery

Development of Atherosclerotic Plaques

Normal

Fatty streak

Lipid-rich plaque Foam cells Fibrous cap

Thrombus

Lipid core

Risk Factors
Uncontrollable
Sex Hereditary Race Age

Controllable
High blood pressure High blood cholesterol Smoking Diabetes Physical activity Obesity Stress and anger

Two major processes in plaque formation

Intimal thickening (Smooth muscle cell proliferation and ECM synthesis)
Lipid accumulation

Response to Injury

Endothelial Dysfunction

Initiation of Fatty Streak

Fatty Streak

Fibro-fatty Atheroma

Gross views of atherosclerosis in the aorta. A, Mild atherosclerosis composed of fibrous plaques, one of which is denoted by the arrow. B, Severe disease with diffuse and complicated lesions (with plaque rupture and superimposed thrombosis), some of which have coalesced

Atherosclerosis

Crystals Cholesterol / Foam Cells

Crystals Cholesterol / Foam Cells

Complications of atherosclerosis
Smaller vessels can become occluded, compromising distal tissue perfusion. Ruptured plaque can give rise to cholesterol emboli Ruptured plaque can lead to thrombus formation Destruction of the underlying vessel wall can lead to aneurysm formation, with secondary rupture and/or thrombosis.

1- Smaller vessels

can become occluded, compromising distal tissue perfusion.

2- Ruptured plaque can give rise to cholesterol emboli

3-Thrombotic complication of atherosclerosis

Complicated plaque showing ulceration, hemorrahage and thromboosis

Thrombosis on top of atheromatous plaques

Complicated plaque showing ulceration, hemorrahage and thrombosis

Dystrophic calcification

4-Destruction of the underlying vessel wall can lead to aneurysm formation, with secondary rupture and/or thrombosis.

Aortic Aneurysm

Aortic Aneurysm

Aortic atherosclerosis, aneurysm and thrombus formation

Aortic atherosclerosis and dissecting aneurysm

Aortic atherosclerosis and dissecting aneurysm

Media

MONKENBERG MEDIAL SCLEROSIS

Monkeberg medial calcific sclerosis

ARTERIOLOSCLEROSIS

L: Narrow lumen I: intemal fibrosis

Reduplication of elastic tissue

M: hypertrophied media

Fibrinoid necrosis

Hyaline arteriolosclerosis

Fibro-elastic hyperplasia

Necrotising arteriolitis

Hyperplastic arteriolosclerosis