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Atherosclerosis Brain

Objective :

 To show the burden of atherosclerosis worldwide

 To describe the pathogenesis of atherosclerosis

 To emphasize the atherosclerosis burden ini cerebrovascular disease

 To emphasize the management of patient with atherosclerosis


 Atherosclerosis is a condition in which patchy deposits of

fatty material (atheroma or atherosclerotic plaques)
develop in the wall of medium sized and large arteries,
leaading to reduced or blocked blood flow.

 It’s a major cause of death and premature disability in

developed societies

 In 2020 it is estimated, atherosclerosis will become the

leading global of total disease burden.

Brain Circ 2015;1:47-52

Endothelial cell role in Atherosclerosis

 Regulation of vasular tone

 Formation of NO (nitric oxide)
 Prostacyclinis and ETS
 Maintain the composition of subendothelial matrix
 Proliferation of smooth muscle cells
 Coagulation
 Fibrinolysis
 Permeability of lipoproteins and plasma protein
 Adhesion and migration of blood cells
Nitric oxide

 A diatomic molecule that has cytoprotective and cytotoxic properites

depenting on its concentration
 The role of nitric oxide to maintain homeostasis :
 Vasodilatation
 Inhibition of platelet adhesion and aggregation
 Reduction of platelet adherence
 Inhibition of small muscle cells proliferation

Circulation Volume 109, Issue 23 suppl

 ET-1 (Endothelin 1):
 A potent vasoconstrictor and mitogen for VSMC
 ROS (Reactive Oxygen Species)
 Produced extracellulary of ROS mainly by action of angiotensin II on
macrophages and endothelial cells
 Ros production is also increased after the stimulation of endothelial cells nu TNF-
alfa and cytokines
 Hypercholesterolemia by balancing the degraddation and production of
natural anti-oxidant
 ROS which produced by polymorphonuclear cells
Risk Factor for Atherosclerosis

 Tobaco uses
 High level of Cholesterol ini the blood
 High blood pressure
 Diabetes
 Obsesity
 Physical activity
 Diet
The Endothelial Dysfunction and

Internet Journal of Medical Update, Vol. 4, No. 1,

January 2009
Pathogenesis Atherosclerosis
Clinical manifestation of brain

Stroke Dementia

 It refers to cerebrovascular disorders because it affect the brain (=cerebro)

and vascular (= blood vessel)
 Stroke : Non valvular AF, stenosis of the carotid arteries, intracranial
atherosclerotic disease
 In Asia population dominated by : intracranial atherosclerotic disease

Arnillas. Stroke. 2011; 42: S20-S23

The Pathologic Change in Stroke

 The magnitude of flow reduction

 A decrease in cerebral blood flow :

 Zero causes the death of brain tissue within 4-10 minutes

 Less than16-18 mL/ 100 gr tissue cause infarction within an hour

 Less than 20 mL/ 100 g tissues per minute causes ischaemia without infaction unles
sprolonged for several hours per or day

 * Will cause hypoxemia, depletion of Glucose and ATP  cell dysfunction

apoptosis and cell death
The Pathogenic change in stroke

 Ischemic stroke :

 Obstruction of the blood vessel

 Hemorrhagic stroke

 Decrease of tissue perfusion

Uncommon cause of stroke : Vol10 May2011

 (A) Inflammatory mechanisms that
promote stroke
 (B) The acute phase of inflammation after
Intracranial atherosclerotic disease

Types of ICAD
1. Thrombotic type
2. Embolism type
3. Hemodynamic
impair rare
4. Branch

Journal of Stroke 2014;16(1):27-

Major Risk Factors for ICAD

Journal of Stroke 2014;16(1):27-

There are three therapeutic strategies
for ICAD :

1. Anti- thrombotics
2. Intervention to prevent
thromboembolism and restore
blood flow, and
3. Identification and control of risk

 Group of symptoms that occur when brain is damaged by spesific disease


 Memory problem

 Communication dificulties

 Problems understanding

 Reduced ability to concentrate

 Mood change
Vascular dementia

 Multi infarct :

 In patients who had several sttrokes which may developed chronic cognitive

 Diffuse white matter disease (Binswanger’s) :

 Appears to result from chronic ischemia due to occlusive disease of small,

penetrating cerebral arteries and arterioles
Management :

 Treatment for atherosclerosis may include :

 Therapeutic lifestyle changes, medicine and medical procedures or surgery

 Follow a healthy diet :

 A healthy diet is an important part of a healthy lifesyle. Following a healthy diet

can prevent of reduce high blood pressure and high blood cholesterol and can
help you maintain a healthy diet
Therapeutic livestyle changes (TLC)

 Reccomended in patient in high blood cholesterol

 TLC consist of healthy diet, physical activity and weight management

 Reccomendation :

 Less than 7% for daily calories chould come from saturated fat ( found in : some meats,
dairy products, chocolate, baked goods and deep fried and processed foods.

 No more than 25 to 35% of your daily calories should come from all fast, including saturated,
trans, monosaturated, and polysaturated fats.

 You also should have less than 200 mg a day of cholesterol

 Additional stenols or sterols

 Include fishes in diet, eg: tuna, salmon (canned or fresh and mackerel).
Two fish meal every week

 Limit ammount of sodium (Salt)

 Limit drink alcohol (calories)

 Men: not more than two drinks per day

 Woman : not more than one drinks per day

Farmacotherapy for Atherosclerosis
Controling of risk factors :

 Control of blood pressure

 Control of blood sugar

 Control of other risk factors

Medical Procedures and Surgery

 Angioplasty

 DSA (digital substraction angiography)

 Carotid end arterectomy

New Medication for Atheroslerosis
Future Treatment and Directions :

 Vaccines against atherosclerosis using antibodies against oxidized LDL

 Daraplanib an inhibitor of the enzyme Lp-PLA (lipoprotenin associated

phospholipase A2) which releases pro inflamatory molecules
(lyzophosphatidilcoline) from oxidized LDL particles

 Metothrexate
Conclusion :

 Atherosclerosis is a burden world wide.

 Determination of risk factors for atherosclerosis are detrimental.

 Atherosclerosis were manifests as cerebrovascular disease.

 Approach in changging the modifiable risk factors are main concern.