Assessing coronary plaque burden and plaque vulnerability: atherosclerosis imaging with IVUS and emerging noninvasive
Paul Schoenhagen1, Steven E Nissen
1Department of Cardiovascular Medicine and Radiology, Section of Cardiovascular Imaging, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Insights
Coronary artery disease mortality is high, often caused by vulnerable plaque rupture. Detecting these plaques before symptoms is crucial, using advanced imaging like intravascular ultrasound, computed tomography, and MRI.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of death, with many events originating from vulnerable plaque rupture.
- Current angiography may miss mildly stenotic but vulnerable lesions, necessitating advanced detection methods.
Purpose of the Study:
- To highlight the importance of identifying vulnerable coronary plaques before clinical events.
- To discuss the role of in vivo tomographic imaging in assessing plaque burden and vulnerability.
Main Methods:
- Review of current understanding of vulnerable plaque rupture.
- Discussion of established invasive (intravascular ultrasound) and emerging noninvasive (computed tomography, magnetic resonance imaging) imaging modalities.
Main Results:
- Vulnerable plaques are prevalent years before clinical manifestation.
- Angiographic lumen evaluation is insufficient for detecting these high-risk lesions.
- In vivo tomographic imaging offers direct visualization of plaque characteristics.
Conclusions:
- Early detection of vulnerable coronary plaques is critical for preventing acute coronary events.
- Advanced imaging techniques are essential for characterizing plaque burden and vulnerability beyond traditional lumenography.
Abstract:
Despite significantly improved preventive and therapeutic options, coronary artery disease remains the major cause of mortality in North America. A large number of acute coronary events, including acute myocardial infarction and sudden cardiac death, occur in patients without prior symptoms because these events are initiated by sudden rupture of mildly stenotic but vulnerable lesions. Recent results demonstrate a high prevalence of such plaques many years before clinical events occur. Because these lesions are mildly stenotic before the event, the angiographic evaluation of the lumen is not sufficient for their detection. Therefore, direct observation of coronary plaque burden and plaque vulnerability with in vivo tomographic imaging modalities is increasingly utilized. Intravascular ultrasound is the most established invasive method with a long clinical track record. More recently, noninvasive modalities including computed tomography and magnetic resonance imaging are emerging.
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