Detection of the vulnerable coronary atheromatous plaque. Where are we now?
Atherosclerosis is a progressive process with potentially devastating consequences and has been identified as the leading cause of morbidity and mortality, especially in the industrial countries. The underlying mechanisms include endothelial dysfunction, lipid accumulation and enhanced inflammatory involvement resulting in plaque disruption or plaque erosion and subsequent thrombosis. However, it has been made evident, that the majority of rupture prone plaques that produce acute coronary syndromes are not severely stenotic. Conversely, lipid-rich plaques with thin fibrous cap, heavily infiltrated by inflammatory cells have been shown to predispose to rupture and thrombosis, independently of the degree of stenosis. Therefore, given the importance of plaque composition, a continuously growing interest in the development and improvement of diagnostic modalities will promptly and most importantly, accurately detect and characterize the high-risk atheromatous plaque. Use of these techniques may help risk stratification and allow the selection of the most appropriate therapeutic approach.
Vaina
Sophia
S
1st Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece.
Stefanadis
Christodoulos
C
D017546:Angioscopy; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D011859:Radiography; D018570:Risk Assessment; D019265:Spectroscopy, Near-Infrared; D013059:Spectrum Analysis, Raman; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional