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An atheroma, or atheromatous plaque, is an abnormal accumulation of material in the inner layer of an arterial wall. [1] [2]The material consists of mostly macrophage cells, [3] [4] or debris, containing lipids, calcium and a variable amount of fibrous connective tissue.
Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney , resulting in renovascular hypertension – a secondary type of high blood pressure .
Generally an atheroma becomes vulnerable if it grows more rapidly and has a thin cover separating it from the bloodstream inside the arterial lumen. Tearing of the cover is called plaque rupture. However, a repeated atheroma rupture and healing is one of the mechanisms, perhaps the dominant one, that creates artery stenosis.
As long as the artery enlarges sufficiently to compensate for the extra thickness of the atheroma, then no narrowing ("stenosis") of the opening ("lumen") occurs. The artery expands with an egg-shaped cross-section, still with a circular opening. If the enlargement is beyond proportion to the atheroma thickness, then an aneurysm is created. [71]
These changes are most prominent in the kidney and can lead to ischemia and acute kidney failure. In the brain, a small cavity called a lacune is an ischemic cavity that can arise due to brain necrosis, due to arteriolosclerosis. [15] [16] Cause. It can be caused by chronic benign (essential) hypertension [17] malignant hypertension. [4] [18]
This leads to a build-up of plaques and they can be deposited in the renal arteries causing stenosis and ischemic kidney disease. [citation needed] In this situation, the kidney supplied blood by the narrowed renal artery suffers from inadequate blood flow, which in turn causes the size of the kidneys to decrease. Other consequences include ...
In treating renal artery disease, a 2014 study indicates that balloon angioplasty can improve diastolic blood pressure and potentially reduce antihypertensive drug requirements. [30] In the case of peripheral artery disease, treatment to prevent complications is important; without treatment, sores or gangrene (tissue death) may occur.
The primary sites of end-target organ damage following an increase in arterial stiffness are the heart, the brain (stroke, white matter hyperintensities (WMHs)), the placenta, and the kidneys (age-related loss of kidney function). [21] Firstly, stiffened arteries compromise the Windkessel effect of the arteries. [22]