PhD defence H.K. (Dianne) van Dam - Nolen

Brief summary of the doctoral thesis:

Since the first discoveries of the pathologist Rudolph Virchow, we have gained many insights in the pathophysiology of ischemic stroke and in carotid atherosclerosis as one of its main causes. Nearly two centuries later, research in this field is going on and is still highly important. Although we have made considerable advances, our knowledge ‘is still a mere island in an ocean of ignorance’. What kind of factors exactly drive initiation, growth or stabilization of carotid atherosclerosis? Could these play a role in identification of patients at high risk of stroke? Or could imaging add to this risk prediction? And, if so, what do we need in the near future to use this knowledge in clinical practice? These are all current knowledge gaps and all highly relevant with regard to the further improvement of stroke care. In this thesis I have focused on these questions, summarized in three aims: 

1.  investigation of determinants of carotid atherosclerosis; 
2. description of the natural course of carotid atherosclerosis; and 
3. identification of plaque characteristics that predict recurrent ischemic strokes.

Most of the studies in this thesis are conducted using data of the Plaque At RISK (PARISK) study, a cohort including patients with symptomatic mild-to-moderate carotid stenosis. The chapter focusing on the relation between immunity and carotid atherosclerosis was embedded within the Rotterdam Study, a population-based cohort study from which we selected patients with subclinical carotid atherosclerosis.