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Updated: Jun 5, 2025
A Human Ex Vivo Atherosclerotic Plaque Model to Study Lesion Biology
Published on: May 6, 2014
Estimating inflammatory risk in atherosclerotic cardiovascular disease: plaque over plasma?
Maxim E Annink1, Jordan M Kraaijenhof1, Cheyenne Y Y Beverloo1
1Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
Insights
Advanced imaging techniques offer precise assessment of vascular inflammation in atherosclerosis, improving patient selection for anti-inflammatory therapies and personalizing cardiovascular disease management.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Inflammation Biology
Background:
- Inflammation is a key factor in atherosclerosis, driving cardiovascular events.
- Current systemic inflammation biomarkers lack specificity for local plaque inflammation.
- Targeting inflammation can reduce cardiovascular risk, but precise patient selection is crucial due to therapy costs and side effects.
Purpose of the Study:
- To review established and emerging non-invasive imaging methods for assessing vascular inflammation in atherosclerosis.
- To highlight the role of advanced imaging in refining risk stratification and guiding personalized therapies.
- To explore the integration of imaging with biomarkers for personalized atherosclerotic cardiovascular disease management.
Main Methods:
- Review of advanced non-invasive imaging techniques including Positron Emission Tomography (PET) tracers (18F-fluorodeoxyglucose, 18F-sodium fluoride, Gallium-68 DOTATATE) and Coronary Computed Tomography Angiography (CCTA).
- Assessment of novel imaging markers like pericoronary adipose tissue attenuation on CCTA.
- Discussion of established biomarkers (e.g., high-sensitivity C-reactive protein) and their limitations.
Main Results:
- Advanced imaging allows direct assessment of vascular inflammation, overcoming limitations of traditional biomarkers.
- PET tracers offer insights into inflammatory cell activity and micro-calcification, while CCTA visualizes plaque features and pericoronary inflammation.
- Emerging imaging modalities enhance specificity and accuracy in identifying vulnerable plaques and guiding therapy.
Conclusions:
- Advanced imaging techniques significantly improve the assessment of atherosclerosis-related inflammation.
- These methods enable more precise patient selection for anti-inflammatory treatments, optimizing risk stratification.
- Integrating imaging with biomarkers promises a personalized approach to managing atherosclerotic cardiovascular disease.
Abstract:
Inflammation is an important driver of disease in the context of atherosclerosis, and several landmark trials have shown that targeting inflammatory pathways can reduce cardiovascular event rates. However, the high cost and potentially serious adverse effects of anti-inflammatory therapies necessitate more precise patient selection. Traditional biomarkers of inflammation, such as high-sensitivity C-reactive protein, show an association with cardiovascular risk on a population level but do not have specificity for local plaque inflammation. Nowadays, advancements in non-invasive imaging of the vasculature enable direct assessment of vascular inflammation. Positron emission tomography (PET) tracers such as 18F-fluorodeoxyglucose enable detection of metabolic activity of inflammatory cells but are limited by low specificity and myocardial spillover effects. 18F-sodium fluoride is a tracer that identifies active micro-calcification in plaques, indicating vulnerable plaques. Gallium-68 DOTATATE targets pro-inflammatory macrophages by binding to somatostatin receptors, which enhances specificity for plaque inflammation. Coronary computed tomography angiography (CCTA) provides high-resolution images of coronary arteries, identifying high-risk plaque features. Measuring pericoronary adipose tissue attenuation on CCTA represents a novel marker of vascular inflammation. This review examines both established and emerging methods for assessing atherosclerosis-related inflammation, emphasizing the role of advanced imaging in refining risk stratification and guiding personalized therapies. Integrating these imaging modalities with measurements of systemic and molecular biomarkers could shift atherosclerotic cardiovascular disease management towards a more personalized approach.
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