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What have we learnt from histology about the efficacy of coronary imaging modalities in assessing plaque composition?
Nathan Angelo Lecaros Yap1, Zahid Khan2,3, Xingwei He1
1Device and Innovation Centre, William Harvey Research Institute Queen Mary University, London, United Kingdom.
Insights
Intravascular imaging aids coronary artery plaque assessment but struggles with predicting vulnerable plaques. Novel approaches are emerging for more comprehensive characterization of atherosclerotic plaques.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Atherosclerosis Research
Background:
- Accurate coronary artery pathology evaluation is crucial for patient risk stratification and treatment.
- Intravascular imaging has been used for 40 years for in vivo plaque characterization.
- Existing modalities have limitations in predicting vulnerable plaques due to challenges in assessing advanced atherosclerotic plaque features.
Purpose of the Study:
- To comprehensively evaluate intravascular imaging performance in characterizing plaque phenotypes.
- To compare available invasive imaging techniques against histology as a reference standard.
- To highlight potential novel intravascular imaging approaches for plaque pathobiology evaluation.
Main Methods:
- Review of studies comparing intravascular imaging modalities with histology.
- Analysis of findings and limitations of existing comparative studies.
- Summary of advancements in novel intravascular imaging techniques.
Main Results:
- Intravascular imaging is indispensable for percutaneous coronary intervention planning.
- Current modalities have limited efficacy in predicting lesion vulnerability.
- Histology remains the reference standard for plaque characterization.
Conclusions:
- Intravascular imaging plays a vital role in assessing coronary artery disease.
- Further development is needed to improve the prediction of vulnerable plaques.
- Novel imaging techniques show promise for a more complete understanding of plaque pathobiology.
Abstract:
Accurate evaluation of coronary artery pathology is essential for risk stratification and tailoring appropriate treatment. Intravascular imaging was introduced for this purpose 40 years ago enabling for the first time in vivo plaque characterization. Since then, several studies have evaluated the efficacy of the existing intravascular imaging modalities in assessing plaque pathology and composition and their potential in guiding intervention and predicting vulnerable plaques. Today it is known that intravascular imaging is an indispensable tool in percutaneous coronary intervention planning, but the existing modalities have a limited efficacy in predicting lesion vulnerability; a fact that should be attributed to their advantages and limitations in accurately assessing morpho-pathological features that are common in advanced atherosclerotic plaques. This review aims to provide a comprehensive evaluation of the performance of intravascular imaging in characterizing plaque phenotypes using histology as a reference standard; it summarizes the studies comparing the available invasive imaging techniques against histology, discusses the findings and limitations of these studies and highlights the potential of novel intravascular imaging approaches that were introduced for a more complete and comprehensive evaluation of plaque pathobiology.
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