Potential Risks of Carotid Plaque Progression Over Time

Recent research highlights that carotid artery plaques, previously considered relatively stable, can undergo significant and potentially dangerous transformations even in individuals without symptoms. A study based on data from the Rotterdam Study in the Netherlands, published in the journal Radiology, reveals that these plaques may increase in complexity over time, developing components such as calcification, internal bleeding, and fatty deposits. Notably, plaques with calcification—once thought to confer stability—are now found to be at higher risk for intraplaque hemorrhage, a key event that can trigger plaque rupture and lead to stroke.

Atherosclerotic plaques are accumulations of lipids, cholesterol, and other substances that build up in the arteries. Over time, they can harden through calcification, which was traditionally believed to reduce rupture risk. However, new imaging techniques like MRI show that calcified plaques may also be prone to internal bleeding, making them more vulnerable than previously thought.

The study tracked 802 participants aged 45 and older with early-stage carotid artery plaques, performing baseline MRIs and follow-up scans after six years. Results indicated that plaque complexity increased, with more features associated with instability, especially in men. Importantly, plaques that already contained calcification were twice as likely to develop internal bleeding, signaling increased vulnerability.

By simulating a 30-year progression, researchers predicted that over half of the participants with simple plaques might develop complex, multi-component plaques by the age of 70, significantly raising their stroke risk. Dr. Daniel Bos emphasized the importance of regular monitoring and managing risk factors such as blood pressure, cholesterol, smoking, and diabetes, even in individuals without symptoms, as plaque changes can occur silently.

The findings underscore the importance of continuous research and advanced imaging techniques to understand plaque evolution better. This knowledge can aid clinicians in early identification of high-risk individuals and prompt preventative measures to reduce the chances of stroke caused by plaque rupture.