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[Atherosclerosis and cerebral ischemia. A systemic process]
J L Martí-Vilalta1, J Martí-Fàbregas
1Unidad de Enfermedades Vasculares Cerebrales, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España.
Insights
Peripheral artery disease indicates systemic atherosclerosis but rarely causes cerebral infarcts. Atherosclerosis affects all arteries, often silently, leading to various vascular complications.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Context:
- Atherosclerosis is a systemic arterial disease with silent progression.
- It can lead to myocardial infarction, cerebral infarct, and peripheral vascular disease.
Purpose:
- To explore the systemic nature of atherosclerosis.
- To analyze the etiological factors of cerebral infarcts.
- To clarify the role of limb atherosclerosis in systemic disease.
Summary:
- Systemic atherosclerosis involves all body arteries, with common risk factors.
- Cerebral infarcts are primarily caused by extracranial artery disease, not intracranial.
- Cardiac embolism is a significant cause of cerebral infarcts.
Impact:
- Highlights the multifocal nature of atherosclerosis.
- Clarifies the less common role of limb atherosclerosis in cerebral infarcts.
- Emphasizes the importance of identifying extracranial and cardiac sources for cerebral infarcts.
Introduction:
Atherosclerosis is a systemic process involving all the arteries of the body. It is often silent, until its progression affects an organ causing a cerebral infarct, myocardial infarct or peripheral vascular disease.
Development:
We consider three distinct aspects of this systemic involvement: the risk factors which are common to atherosclerosis at any site; previous alterations of other vascular regions apart from the current disorder, and the frequent presentation of a new site of vascular disorder, mainly coronary. The authors discuss the evolution of our understanding of cerebral ischaemia and the process of atherosclerosis. Atherosclerosis of the intracranial arteries leading to thrombosis was considered for many years to be the main cause of cerebral infarcts. However, this has been shown to be an unusual cause. The commonest cause has been found to be atheromatosis of the extracranial arteries leading to stenosis, ulceration or thrombosis. The aorta, the artery which is the first and most severely altered by the process of atherosclerosis, is often the cause of a cerebral infarct of unknown aetiology. The embolic etiology of cardiac origin is generally due to valvulopathies and disorders of rhythm and, less frequently, to myocardial ischaemia.
Conclusion:
Atherosclerosis of arteries of the limbs is an indicator of systemic atherosclerosis but not a common etiological factor of cerebral infarct.