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Reports in which stenosis severity was not stated or not similar for symptomatic and asymptomatic patients were excluded. In vitro studies and reports from the coronary circulation were reviewed with regard to the vascular biology of the plaque. Histology studies comparing carotid plaques removed from symptomatic and asymptomatic patients reveal characteristic features of unstable plaques: surface ulceration and plaque rupture (48% of symptomatic compared with 31% of asymptomatic,\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001), thinning of the fibrous cap, and infiltration of the cap by greater numbers of macrophages and T cells. In vitro studies suggest that macrophages and T cells release cytokines and proteinase, which stimulate breakdown of cap collagen and smooth muscle cell apoptosis and thereby promote plaque rupture.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014Infiltration of inflammatory cells to the surface of carotid plaques may be a critical step in promoting plaque rupture and resultant embolization or carotid occlusion. Further understanding of cell recruitment and behavior in carotid atherosclerosis may allow better detection of unstable plaques and therapeutic methods of plaque stabilization.\n          <\/jats:p>","DOI":"10.1161\/01.str.31.3.774","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"774-781","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":331,"title":["The Symptomatic Carotid Plaque"],"prefix":"10.1161","volume":"31","author":[{"given":"Jonathan","family":"Golledge","sequence":"first","affiliation":[{"name":"From the Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger M.","family":"Greenhalgh","sequence":"additional","affiliation":[{"name":"From the Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alun H.","family":"Davies","sequence":"additional","affiliation":[{"name":"From the Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1078-5884(98)80091-9"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.53.1.16"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)93206-O"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800840723"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1979.00500380035003"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.19.8.3135641"},{"key":"e_1_3_2_7_2","first-page":"1083","volume":"19","year":"1998","unstructured":"Bogousslavsky J, van der Melle G, Regli F. 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