Abstract: Endothelial cells appear to constitute a primary target in activation responses to Ischemia to the blood vessel wall that interact with thrombogenesis and atherogenesis. Leukocyte and cytokine action would permit the progression of various pathways in evolution of plaque development based on a vascularized core in the tunica intima. The tunica intima involves systems of repair and response that allow the execution of agonist action towards formulation of various injury patterns. The classic complications of atherosclerotic plaques would integrally participate in the central evolutionary development of the atheromatous plaque based on concepts of Ischemia and injury on the one hand and on aberrant activation and reactivity of the vascular wall and endothelium on the other. It would seem that the main theories in atherogenesis as put forward are different aspects of a process that centrally evolves in terms of a vascular wall injury. Atherosclerosis would involve both incrustation and imbibition pathways of progression based on a response to injury of the vessel wall.