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athero

Inflammatory Atherosclerosis

Richard J. Frink

Sacramento,

2002

© 2002 Richard J. Frink

atherosclerosis

Table of Contents

Book Information
Preface
Acknowledgements
Introduction
Chapter 1 The Beginnings. A Multicentric Disease
- The Injurious Agent
- Response-to-Injury
- Proteoglycans and the Extracellular Matrix
- Adaptive Intimal Thickening
- Early Atherosclerotic Lesions
- Advanced Degeneration
- In Review
- Unanswered Questions
Chapter 2 The Smooth Muscle Cell. The Pivot in Atherosclerosis
- The Fibroproliferative Response
- Atherosclerotic Fibrous Tissue
- Other Types of Vascular Fibrous Tissue
- The Smooth Muscle Cell
- Degeneration and Necrosis
- In Review
- Unanswered Questions
Chapter 3 Inflammation. A Sign of Active Disease
- Chronic Inflammation
- “Active” Inflammatory Atherosclerotic Disease
- Adventitial Inflammation
- The Magnitude of Injury
- Luminal Stenosis and Inflammation
- Failure of Inflammatory Defenses
- Natural History of Wall Injury
- Clinical Manifestations of Atherosclerotic Inflammation
- In Review
- Unanswered Questions
Chapter 4 Atheromas Are Caseous Abscesses
- The Necrotic Core
- Size of Atheroma and Luminal Stenosis
- Atheromas Are Similar to Bacterial Abscesses
- Proteolytic Enzymes
- “Exit” Tracts
- Cleavage Planes
- Plaque Shoulder Ulcerations
- Increased Intraplaque Pressure
- Thermal Heterogeneity
- In Review
- Unanswered Questions
Chapter 5 Calcification: A Physiologic Defense
- Aging and Vascular Calcification
- Calcification and Luminal Stenosis
- Luminal Stenosis without Calcification
- Calcification Is Similar to Bone Formation
- Matrix Vesicles
- Osteoid
- Osteoid and Atherosclerotic Calcification
- Normal Bone and Cartilage
- Evolutionary Purpose
- Reversibility of Coronary Calcification
- Sequence of Events
- In Review
Chapter 6 Adventitia – The Ultimate Defense
- Adventitial Thickening over Atherosclerotic Plaques
- Evolutionary Purpose of Adventitial Thickening
- Adventitial Resistence to the IA
- Histologic Features of Adventitial Thickening
- Significance
- In Review
Chapter 7 Surface Erosions
- Endothelial Vulnerability or Dysfunction
- Proteolytic Enzymes
- Longitudinal Spread of the IA
- Destruction of the Fibrous Cap
- Absence of Resolution
- Frequency of Surface Erosions
- Significance of These Findings
- In Review
Chapter 8 Blind Pockets and False Channels
- False Channels
- Formation of False Channels
- Frequency of False Channels
- Blind Pockets
- Blind Pockets and Acute Occlusions
- Clinical Implications
- In Review
Chapter 9 Thrombosis and the Injurious Agent
- Platelets, Injury Repair and Thrombosis
- Pathologic Hemostasis and Thrombosis
- Thromboregulatory Control
- Luminal Stenosis and Thrombosis
- Wall Injury and Thrombosis
- Evolutionary Purpose
- Clinical Implications
- In Review
Chapter 10 Chronic Ulcerated Plaques
- Chronicity of UPs
- Depth and Extent of UPs
- UPs and Fibrotic Luminal Stenosis
- Component versus Complication
- Early PU Is the Norm
- Absence of Thrombus
- In Review
Chapter 11 What Is the Injurious Agent?
- Single versus Multiple IAs
- Mechanism of Progression
- Evolutionary Purpose
- Single versus Multiple Infectious Agents
- Hypothesis
- Mechanisms of Injury
- Autoimmunity
- In Review
Chapter 12 The Toxic Atheroma
- The Fundamental Acute Lesion
- The Toxic Atheroma
- Embolization of Plaque Tissue
- Initial Symptoms
- Downstream Structures
- In Review
Chapter 13 Plaque Toxins and Clinical Coronary Syndromes
- The Pathogenesis of Angina Pectoris Pain
- Variant (Prinzmetals) Angina (VA)
- Sudden Cardiac Death (SCD)
- Unstable Angina (UA) and Non S-T Segment Elevation Myocardial Infarction (NSTEMI)
- S-T Elevation Myocardial Infarction (STEMI)
- Thrombosis versus Plaque Toxins
- Myocardial Rupture and Thrombolytic Drugs
- Stunned Myocardium
- Silent Ischemia (SI)
- Oral IIB/IIIA Inhibitors
- Aspirin (ASA), UPs, and Plaque Toxins
- Conclusions
- Future Directions
The Injection Technique
References
Abbreviations

Copyright © 2002 Richard J. Frink

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