[Imaging of coronary atherosclerotic plaque]

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Atherosclerosis Research

Background:

• Coronary angiography is standard for defining significant coronary artery disease (CAD) and guiding revascularization.
• Atherosclerotic plaque accumulation precedes significant luminal stenosis, with vulnerable plaques initiating most acute coronary syndromes.
• Angiography alone provides incomplete characterization of early, non-stenotic, yet potentially vulnerable atherosclerotic lesions.

Purpose of the Study:

• To highlight the limitations of coronary angiography in detecting early atherosclerotic disease.
• To discuss the role of advanced imaging modalities in supplementing angiography for comprehensive CAD assessment.
• To explore the potential of non-invasive techniques like computed tomography for early CAD identification and prevention.

Main Methods:

• Review of current imaging modalities for coronary artery disease assessment.
• Comparison of selective coronary angiography with invasive tomographic techniques (e.g., intravascular ultrasound).
• Discussion of emerging non-invasive imaging technologies, focusing on computed tomography.

Main Results:

• Selective coronary angiography excels at defining severe stenosis but is insufficient for characterizing early or vulnerable plaques.
• Invasive tomographic imaging (intravascular ultrasound) provides direct visualization of plaque but is limited by its invasive nature.
• Computed tomography (CT) demonstrates potential for non-invasive imaging of coronary arteries, aiding early CAD detection.

Conclusions:

• Early detection of coronary artery disease (CAD) requires imaging beyond conventional angiography.
• Invasive and non-invasive advanced imaging techniques offer complementary information for understanding CAD progression and plaque vulnerability.
• Computed tomography holds promise for non-invasive, early identification of CAD, potentially preventing complications.