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William M. Feinberg Lecture: Asymptomatic Carotid Stenosis: Current and Future Considerations
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This review of asymptomatic carotid stenosis management identifies microplastics and nanoplastics as an emerging risk factor for cardiovascular disease, alongside traditional atherosclerotic factors. The author notes that strategies to limit microplastic exposure will be important for stroke prevention, as no specific medical therapies currently exist to counteract microplastic-related vascular damage.
Asymptomatic high-grade carotid stenosis is an important therapeutic target for stroke prevention. For decades, the ACAS (Asymptomatic Carotid Atherosclerosis Study) and ACST (Asymptomatic Carotid Surgery Trial) trials provided most of the evidence supporting endarterectomy for patients with asymptomatic high-grade stenosis who were otherwise good candidates for surgery. Since then, transfemoral/transradial carotid stenting and transcarotid artery revascularization have emerged as alternatives to endarterectomy for revascularization. Advances in treatments against atherosclerosis have driven down the rates of stroke in patients managed without revascularization. SPACE-2 (Stent-Protected Angioplasty Versus Carotid Endarterectomy-2), a trial that included endarterectomy, stenting, and medical arms, failed to detect significant differences in stroke rates among treatment groups, but the study was stopped well short of its recruitment goal. CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) will be able to clarify whether revascularization by stenting or endarterectomy remains efficacious under conditions of intensive medical management. Transcarotid artery revascularization has a favorable periprocedural risk profile, but randomized trials comparing it to intensive medical management are lacking. Features like intraplaque hemorrhage on MRI and echolucency on B-mode ultrasonography can identify patients at higher risk of stroke with asymptomatic stenosis. High-grade stenosis with poor collaterals can cause hemispheric hypoperfusion, and unstable plaque can cause microemboli, both of which may be treatable risk factors for cognitive impairment. Evidence that there are patients with carotid stenosis who benefit cognitively from revascularization is presently lacking. New risk factors are emerging, like exposure to microplastics and nanoplastics. Strategies to limit exposure will be important without specific medical therapies.
More Papers Like This
Abstract Tu0030: Carotid Plaque Microplastics are Associated with Clinical Symptoms and Mesenchymal Stem Cell-Macrophage Immunomodulatory Effects
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This conference abstract reports findings from a study linking micronanoplastic content in carotid artery plaques with clinical symptoms and with altered immune signaling mediated by mesenchymal stem cells. Patients with symptomatic carotid stenosis had higher plaque microplastic loads, and stem cells modulated the inflammatory response in ways that differed based on microplastic presence.
Abstract 16911: Burden of Micro(nano)plastics and Complicated Plaque Phenotype in Human Carotid Atherosclerotic Plaques
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Researchers examined plaque tissue removed from 22 human carotid arteries, measuring tiny plastic particles of different sizes. Plaques with complications like rupture or hemorrhage had higher levels of nanoplastics (smaller particles), but not microplastics, compared to plaques without these features. Polyvinyl chloride was the most common plastic type found.
Microplastics and Nanoplastics in Cardiovascular Disease: An Emerging Cardiovascular Risk Factor
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Researchers reviewed mounting experimental and early clinical evidence that microplastics and nanoplastics cross epithelial barriers, accumulate in arterial plaques, cardiac tissue, and thrombi, and trigger oxidative stress and coagulation dysregulation, framing these particles as an emerging cardiovascular risk factor that warrants integration into disease prevention frameworks.
Abstract Tu0030: Carotid Plaque Microplastics are Associated with Clinical Symptoms and Mesenchymal Stem Cell-Macrophage Immunomodulatory Effects
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Tiny plastic particles (called microplastics) can build up in the fatty plaque that clogs neck arteries, and this study found that higher levels of these plastics were linked to patients actually having stroke-like symptoms, not just silent artery blockages. The researchers also looked at how the body's stem cells and immune cells respond to these plastic deposits, suggesting a possible reason why plastic buildup might make plaque more dangerous. This adds to growing concerns that the microplastics we're exposed to daily may play a real role in heart and blood vessel disease, though more research is needed to confirm exactly how.
Microplastics and Nanoplastics as Emerging Contributors to Cardiovascular Disease: Mechanisms, Clinical Evidence, and Therapeutic Opportunities
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Researchers reviewed clinical and mechanistic evidence linking microplastic and nanoplastic exposure to cardiovascular disease, noting that MNPs have been detected in arterial plaques and associated with higher rates of adverse cardiac events, and proposed interaction-based sequestration strategies and lipid nanoparticle therapeutics as potential mitigation avenues.
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