Atherosclerotic plaque burden, plaque vulnerability and arterial remodeling: the role of inflammation

Atherosclerotic narrowing of the arterial lumen is caused by gradual plaque growth and arterial remodeling. Expansive remodeling retards and constrictive remodeling accelerates narrowing of the lumen by plaque accumulation. In the acute phase luminal narrowing may be accelerated by rupture of a vulnerable plaque and subsequent thrombus formation. Inflammatory cells are key players in all these determinants of atherosclerotic luminal narrowing. Inflammatory cells are present in both early and advanced stages of atherosclerosis. Chronic infections have been suggested as trigger of arterial inflammation, but no causal relationship has yet been proved. Systemic markers of inflammation, like C-reactive protein, are predictors for the occurrence of future adverse cardiovascular events, confirming the role of inflammatory responses in arterial occlusive disease. In this review the central role of inflammation in atherosclerotic luminal narrowing will be discussed.