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The loss of the protective endothelial covering allows blood to come in contact with the highly thrombogenic contents of collagen and/or necrotic core of the plaque and luminal thrombosis to occur. This occurs with either plaque rupture or plaque erosion, both of which are considered __________ __________.

vulnerable plaques


Other mechanisms of ACS, such as a ______-______ ________, may be causative.

supply-demand mismatch


______ ______ is the major cause of acute coronary thrombi (70%).

plaque rupture

It is characterized by lesions that exhibit relatively large necrotic cores with a thin disrupted fibrous cap. Luminal blood comes in direct communication with the necrotic core and thrombosis may result.


The precise pathogenetic mechanism of plaque rupture is ______.


Factors such as the destruction of extracellular matrix within the fibrous cap by metalloproteinases as well as macrophage apoptosis and the influence of local rheological forces are likely involved.


Ruptured plaques are associated with positive remodeling. Thus a high percentage of acute coronary syndromes are seen attributed to plaque rupture occur in lesions with ___% percent diameter stenosis. 


Repeat ruptures, which may or may not be silent, are likely responsible for plaque progression and the formation of obstructive lesions.


Pathogenetic mechanisms of plaque erosion are ______ __________.

poorly understood

The presence of hyaluronan in the superficial layers close to the thrombus suggests their role in deendothelialization and platelet adherence.