Inflammation and immune response in carotid artery stenosis

Atherosclerosis (ATS) is a multifactorial inflammatory disease representing the major cause of cardiovascular disease (ASCVD). Among ASCVD, carotid artery stenosis (CS) represent a serious health problem worldwide causing =10% of strokes. Immune response underlying ATS is complex and is characterized by the activation of both innate and adaptive immune responses. In this review article has been revised the contribution of the main cell populations and mediators involved in ATS. Monocytes play a central role in atherogenesis by their ability to differentiate into macrophages, thus leading to lipid accumulation and foam cells formation. T lymphocytes are present into the atherosclerotic plaque, where, in response to the local milieu of cytokines, differentiate into different subpopulations. The role of B cells in ATS is still under evaluation, due also to B cell heterogeneity. Mast cells, by release of their contents, may actively contribute to atherosclerotic plaque progression and destabilization. Matrix metalloproteinases and cytokines are also involved in atherosclerotic process. Mechanisms underlying CS are complex and are influenced by inflammatory immune response occurring during ATS. Thus, beside information coming from neuroimaging and laboratory data, the knowledge of immunologic mechanisms could contribute to improve treatment decisions for these patients