**15. Thrombosis**

The thrombus that is deposited on the surface of plaques is also an attempt at streamlining the luminal contours of the vessel wall in an attempt to accommodate new flow dynamics.

The response to injury hypothesis only partly accounts for the pathogenesis of an athero‐ sclerotic plaque that is centered on a core of involvement of the vascular intima. It is the ad‐ ditional formulation of a hypoxic micro-environment that further proves a driving initiative in the development of serial plastic events that conformationally confirm the dimensions of a plaque reconstitution at the interface of abnormal blood flow dynamics. Hence, the redis‐ tributional series of phenomena come to model the individual lesion as hypoxic condition‐ ing of the micro-environment and of attempts at neovascularization at the base of the lesion.

Developmental dynamics hence are paramount considerations in the evaluation of a specific plaque dimensionality. The overall conformations of lesions are centrally operative but dy‐ namically progressive in the face of both accumulative and transforming pathways of ago‐ nist action and response adaptations. Hyperinsulinemia appears to promote macrophage foam cell formation and may thus promote atherogenesis in type-2 diabetics [27].
