Episode 19- Formation and development of atherosclerotic plaque

Episode 19- Formation and development of atherosclerotic plaque

Up until the 60s, the solution to coronary artery disease, namely angina and myocardial infarction, was balloon angioplasty or bypass surgery.

In the first case, the strategy used was to crush the atheromatous plaque.  The second technique, bypass surgery, is an intervention that consists in installing bridges over the partial or total obstruction of the coronary artery.

Nothing in these practices addresses the source of the problem, the atheromatous plaque, which remains unexplained until today. There is no consensus or formal agreement on this issue.

Dr. Ross’ work will make a difference.


Professional training and practice

Dr. Ross graduated in Dentistry from the Columbia University College of Dental Medicine, New York, in 1955. After seven years of additional studies, he obtained a degree in experimental pathology from the University of Washington, in Seattle.

He then joined the teaching staff at the University of Washington. He was appointed professor and dean of the Faculty of Pathology. Sometime later, he became chairman of the Department of Pathology.


Curiosity leads him to a discovery

Dr. Ross focused mainly on wound-healing mechanisms. His studies made him wonder: could the wound-healing process give rise to disease, given particular circumstances? As if yin was the healing process and yang its harmful opponent.


Dr. Ross makes an astonishing discovery! The cells he found were identical to those present on the periphery or edge of atheromatous plaques. His hypothesis is confirmed. The atheromatous plaque formation is the response to cholesterol accumulation on the wall of the coronary artery, an inflammatory reaction.


A happy ending

His momentous finding would finally allow the merging of the two existing hypotheses, which were ardently defended by each of their protagonists. They were right, to some extent: the lipid hypothesis was the other one’s cause, the inflammatory response. Both hypotheses were responsible for the existence of cholesterol plaque as well as for its evolutionary process.


Everything becomes clearer

What happens next is more or less a chain reaction that may be compared to domino tiles, falling sequentially one after the other. We knew about the mechanism of plaque formation and could demonstrate that the plaque was a dynamic element that could rupture at any time.

We were also aware that a rupture exposed the plaque material to the bloodstream, activating the blood coagulation cascade with the birth of a thrombus that could partially or completely obstruct the coronary artery. Hence, a heart attack!

The real enemy was finally known!


Dr. Russell Ross passed away on March 18, 1999, in Seattle, Washington.