Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


On the problem of neovascularization of carotid atherosclerotic plaques

Authors: Shumilina M.V., Hayroyan A.G

DOI: https://doi.org/10.24022/1814-6910-2025-22-3-236-248

UDC: 616.13-004.6-089

Link: Clinical Physiology of Blood Circulaiton. 2025; (): -

Quote as: Shumilina M.V., Hayroyan A.G. On the problem of neovascularization of carotid atherosclerotic plaques. Clinical Physiology of Сirculation. 2025; 22 (3): 236–248 (in Russ.). DOI: 10.24022/1814-6910-2025-22-3-236-248

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Abstract

The article considers the relevance of studying the neovascularization of atherosclerotic plaques of the internal carotid arteries as a criterion of its complication. Pathomorphological features and possibilities of visualization of non-vessels are analyzed. The search was performed in PubMed, Сochranelibrary and Сyberleninka systems. Conclusions: All carotid plaques contain microvessels. With contrast enhancement of ultrasound examinations, neovascularization (CEUS) was detected in all plaques without significant differences between different types according to the classification of A. Gray-Weale. Hypoechoic plaques have higher degrees of neovascularization. The average diameter of the vessels that can be detected during CUSIS was 30 microns. The presence of “small” (< 20 microns) non-vessels indicates a high activity of the atherosclerotic (or even inflammatory) process; and the detection of “large” (> 40 microns) vessels indicates a high reparative potential and a sign of stabilization. The density of non-vessels is significantly higher in symptomatic than in asymptomatic plaques. Intra-plaque non-vessels in the middle region of carotid plaques are closely associated with symptomatic carotid stenosis, intra-plaque hemorrhage, and rupture of the fibrous cap. Symptomatic plaques significantly correlate with stronger contrast effects in luminal CUSIS than in adventitia (p = 0.0095). The registration of a high density of non-vessels in the plaque thickness is accompanied by an increased risk of developing end and intermediate points of patient observation; and the severity of calcification, connective tissue and lipid degeneration was not associated with a significant increase in the risk of cardiovascular complications. From the point of view of pathophysiology, it remains unclear whether vasa vasorum remodeling causes disease progression, controls it, or is a consequence of cardiovascular pathologies, as well as the issue of hemodynamics in non-vessels.

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