Identification of vulnerable atherosclerotic plaques

Abstract

There has been great interest in the possibility of identifying plaques that might be the site of future acute coronary events. These plaques are termed vulnerable and the majority are lipid-rich with an abundance of inflammatory cells and a thin fibrous cap. Several techniques developed to identify these plaques are in various stages of development and in the near future, one might employ a strategy to potentially identify and therapeutically modify such lesions during percutaneous intervention to avoid future acute events. Although this approach of identifying the vulnerable plaque seems promising, there are significant potential limitations. The natural history of a vulnerable plaque is unknown and clinical trials utilizing this strategy of identification and therapeutic intervention are lacking. Moreover, in any given patient, multiple vulnerable plaques are likely to be present. This article reviews some of the techniques for identifying a vulnerable plaque and discusses the potential advantages and limitations of this strategy.

Biomarkers of Cardiovascular Disease

“…Molecular imaging will likely facilitate targeted therapy of CVD on the basis of the molecular elements delineated in diseased tissue. 218 For example, newer targeted contrast agents are being developed for plaque characterization: "by identifying fibrin within plaque microfissures, 219 adhesion or thrombogenic molecules expressed on endothelium of vulnerable plaques, 220 matrix metalloproteinases in the cores of progressive lesions, 221 or the early angiogenic expansion of the vasa vasorum that supports plaque development." 222,223 Plaques that look morphologically similar (in terms of lipid core and fibrous cap) may be distinguished with techniques such as thermography, 224 multicontrast MRI, 219,225 and intravascular optical coherence tomography.…”

Quantifying Effects of Plaque Structure and Material Properties on Stress Distributions in Human Atherosclerotic Plaques Using 3D FSI Models

“…), chemical environment, and lumen surface conditions (inflammation) [4][5][6]. Some studies indicate that the following appear to be closely associated with plaque ruptures [7][8][9][10][11]: (a) a large atheromatous lipid-rich core; (b) a thin fibrous cap; (c) weakening of the plaque cap, superficial plaque inflammation, and erosion. MRI techniques have been developed to non-invasively quantify plaque size, shape, and components (fibrous, lipid, calcification/inflammation) [12].…”