When plaque builds up in arteries how does it get removed?
In: Biology
It doesn’t.
Atherosclerosis is a progressive disease, moves one direction. Plaques grow over time.
Now, the most dangerous plaques are unstable ones. Plaques that are inflamed and which can rupture causing a thrombosis which causes a clot which gets lodged in a narrowing. Plaques can stabilize, get calcified over time. And so, say if someone has built up plaques, but then goes on some LDL lowering medications, then the existing plaques could become stable such that they no longer present much of a threat. You can actually have a substantial narrowing of an artery but not be at risk if you don’t throw large clots off.
When someone has a complete blockage (if to the heart, a heart attack, if to the brain a stroke) the plaque can be stented – opened up with a balloon inserted through, a catheter, and then held open with a small wire stent that keeps the opening from closing up once the balloon is removed. Eventually the wire gets coated with lining of the artery. The plaque itself does not go away – it just got shoved open and pushed aside to allow the blood to flow again.
There is possibly some evidence that extreme lowering of LDL can result in regression of plaques. But we’re in early days having such medications (PCSK9 inhibitors mostly) that can lower LDL this dramatically. It may be years before we get definitive proof that such regression happens.
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