Histopathology and pathogenesis of plaque instability and thrombus formation

Our knowledge of the pathogenesis of plaque instability has undergone profo und changes in recent years. Research in this field has been driven by the fact that atherosclerosis and its thrombotic complications continue to be t he major cause of mortality and morbidity throughout the industrialized wor ld. The different types of atherosclerotic lesions, mechanisms of atheroscl erotic progression, plaque vulnerability and rupture are now better underst ood. This has led to evolution of therapeutic strategies designed to stabil ize atherosclerotic plaque and to reduce progression. Furthermore, knowledg e of mechanisms leading to thrombosis after plaque rupture have led to the development of antithrombotic strategies to prevent and reduce complication s arising from such an event. This review will describe the histopathology and pathogenesis leading to plaque instability the factors associated with subsequent rupture and assess the role of thrombosis in the progression of atherosclerotic disease. We will focus on current therapeutic strategies to identify and reduce vulnerable plaques and speculate on future areas for r esearch. (C) 1999 Prous Science. All rights reserved.