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Peripheral Artery Disease: causes and consequences

Coronary Artery Disease: causes and consequences

Arterial Thrombosis

This section focuses on the role of atherosclerosis in the formation of arterial thrombi and discusses their risk factors, epidemiology and associated complications

Arterial Thrombosis Explained

Video to explain the mode of action of arterial thrombosis. Play this video to get an overview about arterial thrombosis.

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Arterial thrombi

  • When a thrombus forms within an artery, this is known as an arterial thrombosis
  • Clot formation is typically triggered by the rupture of an atherosclerotic plaque, a highly thrombogenic event, with platelets rapidly recruited to the site
    • The fibrin content of the clot slowly increases as the thrombus extends into the arterial lumen
    • Thus, an arterial thrombus is typically platelet-rich, fast growing, and exposed to fast blood flow1,2
  • AF-related thrombi are also categorized as arterial clots, but more closely resemble ‘venous-type’ clots, fulfilling Virchow’s triad for thrombogenesis
  • AF-related thrombi form in low-flow, low-pressure environments, producing slow-growing, fibrin-rich clots2

 

Risk factors

  • Important risk factors for arterial thrombosis include:3
    • Smoking
    • Obesity
    • High blood pressure
    • Increased levels of cholesterol
    • Diabetes
    • Increasing age
    • Family history
    • Physical inactivity
    • Increased concentrations of blood coagulation factors
    • Blood serum lipid abnormalities

 

Incidence and prevalence

  • Atherosclerotic lesions develop throughout the arterial system and, depending on the vascular bed most affected, disease can manifest as CAD, PAD or cerebrovascular disease
    • CAD is the most commonly diagnosed form of cardiovascular disease, in which atherosclerosis damages the coronary artery wall predisposing to thrombus formation
    • The symptoms and severity of ACS (unstable angina and MI) vary depending on the degree to which thrombi occlude the coronary arteries4
  • The incidence and prevalence of the clinical manifestations of arterial thrombosis are high
    • In 2016, CAD and peripheral vascular disease made up 3.8% of all cases of disease and injuries captured by the Global Burden of Disease study and 58.3% of all CV disease5
    • Over 9% of respondents to the European Social Survey (2014) reported heart or circulation problems6
    • CAD and stroke are the leading causes of death worldwide, accounting for 15.2 million deaths in 2016 (~27% of all deaths)7
    • Two-fifths of CV disease deaths in Europe are in patients under the age of 75 years (accounting for 1.4 million deaths in patients <75 years and 683,364 deaths in patients <65 years)6

 

Complications

  • Arterial-type clots can result in MI and unstable angina (ACS events),8,9 ischaemic stroke,10 and some manifestations of PAD, such as acute limb ischaemia11
  • Thrombi characteristics are an important consideration for the development of treatment/prevention strategies (i.e. anticoagulant/antiplatelet)1,2
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Coronary bypass graft completely occluded by acute thrombosis (arrow)

References
  • Mackman N. Triggers, targets and treatments for thrombosis. Nature 2008;451:914–918. Mackman N. Triggers, targets and treatments for thrombosis. Nature 2008;451:914–918. Return to content
  • Turpie AGG, Esmon C. Venous and arterial thrombosis – pathogenesis and the rationale for anticoagulation. Thromb Haemost 2011;105:586–596. Return to content
  • Previtali E, Bucciarelli P, Passamonti SM, Martinelli I. Risk factors for venous and arterial thrombosis. Blood Transfus 2011;9:120–138. Return to content
  • Fuster V, Moreno PR, Fayad ZA et al. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol 2005;46:937–954 Return to content
  • GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211–1259. Return to content
  • Townsend N, Wilson L, Bhatnagar P et al. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37:3232–3245. Return to content
  • World Health Organization. The top 10 causes of death. 2017. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/ [accessed 30 August 2018]. World Health Organization. The top 10 causes of death. 2017. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/ [accessed 30 August 2018]. Return to content
  • Steg PG, James SK, Atar D et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC). Eur Heart J 2012;33:2569–2619. Return to content
  • Roffi M, et al. Eur Heart J. 2016;37:267-315. Return to content
  • Lansberg MG, O'Donnell MJ, Khatri P et al. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e601S–e636S. Return to content
  • Aboyans V, Ricco JB, Bartelink MEL et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017;55:305–368. Return to content

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