Vasa vasorum imaging: a new window to the clinical detection of vulnerable atherosclerotic plaques
Stéphane Carlier1, Ioannis A Kakadiaris, Nabil Dib
1Association for Eradication of Heart Attack-AEHA, 2472 Bolsover #439, Houston, TX 77005, USA.
Insights
Identifying vulnerable plaques causing heart attacks and strokes is challenging. New microbubble contrast-enhanced intravascular ultrasound (IVUS) can assess plaque activity by imaging vasa vasorum density, improving detection.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Biomedical Engineering
Background:
- Vulnerable atherosclerotic plaques pose a significant risk for heart attacks and strokes due to complications like rupture and thrombosis.
- Current methods for identifying vulnerable plaques, including advanced imaging techniques, lack clinical approval.
- Intravascular ultrasound (IVUS) is a widely used tool for intracoronary procedures but struggles to assess plaque activity.
Purpose of the Study:
- To review new evidence on microbubble contrast-enhanced IVUS for assessing atherosclerotic plaque activity and inflammation.
- To highlight the potential of vasa vasorum density as a marker for plaque vulnerability.
- To propose a combined approach using IVUS for structural assessment and vasa vasorum imaging for comprehensive vulnerable plaque characterization.
Main Methods:
- Review of recent scientific literature on intravascular ultrasound (IVUS) and atherosclerotic plaque characterization.
- Focus on microbubble contrast-enhanced IVUS techniques for imaging vasa vasorum.
- Evaluation of vasa vasorum density as a biomarker for plaque vulnerability.
Main Results:
- Microbubble contrast-enhanced IVUS demonstrates the ability to measure plaque activity and inflammation by imaging vasa vasorum density.
- Increasing evidence supports vasa vasorum density as a strong indicator of plaque vulnerability.
- Combining structural plaque assessment with vasa vasorum imaging via IVUS offers a powerful clinical tool.
Conclusions:
- Microbubble contrast-enhanced IVUS provides a novel method for assessing plaque activity and inflammation.
- Vasa vasorum density is a promising marker for identifying vulnerable atherosclerotic plaques.
- A multimodal IVUS approach combining structural analysis and vasa vasorum imaging represents the most potent clinically available tool for vulnerable plaque characterization.
Abstract:
Complications of vulnerable atherosclerotic plaques (rupture, luminal and mural thrombosis, intraplaque hemorrhage, rapid progression to stenosis, spasm, and so forth) lead to heart attacks and strokes. It remains difficult to identify what plaques are vulnerable to these complications. Despite recent developments such as thermography, spectroscopy, and magnetic resonance imaging, none of them is approved for clinical use. Intravascular ultrasound (IVUS), a relatively old yet widely available clinical tool for guiding intracoronary procedures, is increasingly used for characterization of atherosclerotic plaques. However, inability of IVUS in measuring plaque activity limits its value in detection of vulnerable plaques. In this review, we present new information suggesting that microbubble contrast-enhanced IVUS can measure activity and inflammation within atherosclerotic plaques by imaging vasa vasorum density. An increasing body of evidence indicates that vasa vasorum density may be a strong marker for plaque vulnerability. We suggest that a combination of structural assessment (cap thickness, lipid core, calcification, etc) and vasa vasorum density imaging by IVUS can serve as the most powerful clinically available tool for characterization of vulnerable plaques. Due to space limitations, all IVUS images and movies are posted on the website of the Ultimate IVUS Collaborative Project: http://www.ultimateivus.com.
