La presentazione è in caricamento. Aspetta per favore

La presentazione è in caricamento. Aspetta per favore

Una Patologia Polidistrettuale: lAterotrombosi Plinio Fabiani 3 ottobre 2009 Ospedale San Giovanni di Dio Firenze.

Presentazioni simili


Presentazione sul tema: "Una Patologia Polidistrettuale: lAterotrombosi Plinio Fabiani 3 ottobre 2009 Ospedale San Giovanni di Dio Firenze."— Transcript della presentazione:

1 Una Patologia Polidistrettuale: lAterotrombosi Plinio Fabiani 3 ottobre 2009 Ospedale San Giovanni di Dio Firenze

2 What is Atherothrombosis? Atherothrombosis is characterized by a sudden (unpredictable) atherosclerotic plaque disruption (rupture or erosion) leading to platelet activation and thrombus formation Atherothrombosis is the underlying condition that results in events leading to myocardial infarction, ischemic stroke, and vascular death Plaque rupture 1 Plaque erosion 2 1. Falk E et al. Circulation 1995; 92: 657– Arbustini E et al. Heart 1999; 82: 269–72.

3 La due fasi dellatero-trombosi

4 Infarto Miocardico Acuto

5 Atherothrombosis: A Generalized and Progressive Process Unstable angina MI Ischemic stroke/TIA Critical leg ischemia Cardiovasculardeath ACS Atherosclerosis Adapted from Stary HC et al. Circulation. 1995; 92: 1355–74, and Fuster V et al. Vasc Med. 1998; 3: 231–9. Stable angina Intermittent claudication Atherothrombosis

6

7

8 Major Clinical Manifestations of Atherothrombosis Adapted from: Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 1–6. Transient ischemic attack Angina: Stable Unstable Ischemic stroke Myocardial infarction Peripheral arterial disease: Intermittent claudication Rest Pain Gangrene Necrosis

9 Plaque rupture Platelet activation and aggregation Non-occlusive thrombus Acute syndrome: coronary cerebrovascular peripheral Occlusive thrombus Healing and resolution Plaque growth The Development of Atherothrombosis – a Generalized and Progressive Process Adapted from: Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 1–6.

10 Atherothrombosis and Microcirculation Adapted from: Topol EJ, Yadav JS. Circulation 2000; 101: 570–80, and Falk E et al. Circulation 1995; 92: 657–71. Plaque rupture Microvascular obstruction Embolization

11

12 Atherothrombosis * is a Leading Cause of Death Worldwide 1 1. The World Health Report Geneva: WHO; Mortality (%) *Cardiovascular disease, ischemic heart disease and cerebrovascular disease Worldwide defined as Member States by WHO Region (African, Americas, Eastern Mediterranean, European, South-East Asia and Western Pacific)

13 Identifying Those at Risk of Atherothrombosis 1,2 1. Yusuf S et al. Circulation 2001; 104: 2746– Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 1–6. Lifestyle Smoking Diet Lack of exercise Genetic Genetic traits Gender Age Generalised disorders Obesity Diabetes Systemic conditions History of vascular events Hypertension Hyperlipidemia Hypercoagulable states Homocystinemia Local factors: Elevated prothrombotic factors: fibrinogen, CRP, PAI-1 Blood flow patterns, vessel diameter, arterial wall structure Atherothrombosis manifestations (myocardial infarction, stroke, vascular death)

14 Il fumo uccide!

15 Atherothrombosis is a Systemic Disease: Increased Risk of Stroke in Patients After a Myocardial Infarction 1 1. Lichtman JH et al. Circulation 2002; 105: 1082– or more Six month stroke admission rate Number of risk factors

16 Calcificazioni coronariche Laterosclerosi coronarica è il più comune fattore predisponenete per laterostrombosi

17 Atherothrombosis is a Systemic Disease: Long-Term Risk Increase for Stroke As a Function of Coronary Calcification 1 1. Vliegenthart R. Stroke 2002; 33: 462– x –100101–500> 500 Coronary calcium score Risk increase

18

19 1. OLeary DH. N Engl J Med 1999; 340: 14– x Quintiles of carotid artery media thickness Risk increase Atherothrombosis is a Systemic Disease: Long-term Risk Increase for Myocardial Infarction as a Function of Carotid Intima Media Thickness 1

20

21 Indice di Winsor (braccio/caviglia)

22 1. Dormandy JA, Creager MA. Cerebrovasc Dis 1999; 9(suppl 1): 14. Atherothrombosis is a Systemic Disease: Increase for Myocardial Infarction and Stroke as a Function of ABI Measurement 1 x Ankle-brachial index (ABI) index Risk increase

23 Causes of Death During Different Time Intervals after First-Ever Stroke 1 1. Hankey GJ. Stroke 2000; 31: 2080–6. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 30 days30d–6m6m–1yr1–3yr3–5yr Time Proportion of deaths (%) Unknown Non-vascular Cardiovascular Recurrent stroke Related to first stroke

24 Manifestations of Atherothrombosis are Commonly Found in More than One Arterial Bed in an Individual Patient *1 1. Coccheri S. Eur Heart J 1998; 19(suppl): P1268. Coronary disease Cerebrovascular disease Peripheral arterial disease 24.7% 3.8% 11.8% 29.9% 3.3% 7.4% 19.2% *Data from CAPRIE study (n=19,185)

25 Conclusioni LAterotrombosi è caratterizzata da unimprovvisa rottura di placca che determina attivazione piastrinica e formazione del trombo 1 Laterotrombosi rappresenta il legame patologico comune a tutte le maggiori manifestazioni cliniche delle malattie vascolari: infarto del miocardio, ictus ischemico ed ateriopatia obliterante periferica 2 Pazienti con manifestazioni cliniche di aterotrombosi in un letto vascolare non sono solo a rischio di un evento ricorrente nella stessa distribuzione arteriosa, ma corrono il rischio di eventi ischemici anche in altri letti vascolari 3 LAterotrombosi è la maggiore causa di mortalità nel mondo intero 4 1. Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 1–6. 2. Nenci GG. Eur Heart J 1999; 1(suppl A): A27–A Lichtman JH et al. Circulation 2002; 105: 1082–7. 4. The World Health Report Geneva: WHO; 2002.


Scaricare ppt "Una Patologia Polidistrettuale: lAterotrombosi Plinio Fabiani 3 ottobre 2009 Ospedale San Giovanni di Dio Firenze."

Presentazioni simili


Annunci Google