Pathobiology of the asymptomatic atherosclerotic carotid plaque

The atherosclerotic plaque at the carotid bifurcation is an example of the advanced fibrous plaque found at sites of predilection throughout the arterial system (Figure 2.1). Carotid atherosclerotic plaques are composed of a dense cap of connective tissue embedded with a few smooth muscle cells, overlying a core of lipidic and necrotic debris. Typically, the accumulating plaque burden is initially accommodated by an adaptive positive remodeling with expansion of the vessel external elastic lamina and minimal changes in lumen size.1