Future Trends in Intravascular Imaging

Future Trends in Intravascular Imaging

George D. Giannoglou (AHEPA University General Hospital, Greece) and Yiannis S. Chatzizisis (AHEPA University General Hospital, Greece)
DOI: 10.4018/978-1-61350-095-8.ch020
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Abstract

Vulnerable plaques have certain histopathologic and regional characteristics. The advent of novel invasive and non-invasive imaging modalities aim to identify the histopathologic and regional characteristics of vulnerable plaque, thereby enabling the early diagnosis and potential application of treatments strategies to avert future acute coronary events.
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Introduction

Although all coronary artery lesions are exposed to the same systemic risk factors, each of these atherosclerotic lesions presents its own potential for progression and risk. A portion of atherosclerotic lesions are thin capped fibroatheromas (also called high-risk or thrombosis-prone or vulnerable plaques) prone to acute disruption, and consequent acute coronary syndrome. Histopathology studies indicate that more than 75% of vulnerable plaques obstruct the coronary lumen by less than 50% prior to rupture, and do not limit coronary flow nor produce angina (Kolodgie, et al., 2004), (Virmani, Burke, Farb, & Kolodgie, 2006). These lesions are currently neither identified nor treated before plaque rupture. Plaque rupture with superimposed thrombosis is the predominant cause of acute coronary syndromes and sudden coronary death.

Vulnerable plaques have certain histopathologic and regional characteristics which are summarized in Table 1. The histopathologic characteristics include a thin, intensely inflamed fibrous cap measuring < 65μm, separating a large necrotic core from fluid-phase risk factors. The fibrous cap contains less collagen and reduced content of vascular smooth muscle cells. A dense network of neovessels may also develop in the plaque. The vulnerable plaques develop in regions characterized by low endothelial shear stress (ESS), severe internal elastic lamina fragmentation and expansive vascular wall remodelling.

Table 1.
Characteristics of vulnerable plaques as potential targets of novel imaging modalities
Histopathologic characteristicsRegional characteristics
Large necrotic coreLow endothelial shear stress
Severe inflammationSevere internal elastic lamina degradation
Extracellular matrix remodellingExpansive vascular remodelling
Thin fibrous cap
Reduced vascular smooth muscle cells
Neovascularization

Advent of novel invasive and non-invasive imaging modalities aim to identify the abovementioned histopathologic and regional characteristics of vulnerable plaque, thereby enabling the early diagnosis and potential application of treatments strategies to avert future acute coronary events.

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