Vulnerable plaque intervention: State of the art.
Progressive atherosclerotic disease is responsible for many of the late adverse clinical events that detract from the high procedural and clinical success of percutaneous coronary intervention. Despite recent advances in catheter based technology for the treatment of obstructive coronary artery disease, the greater risk to the patient over time may in fact come from the significant rate of acute coronary events triggered by nonculprit and/or nonobstructive coronary artery lesions. These areas of vulnerability within the epicardial coronary tree have generated a great deal of interest surrounding the concepts of vulnerable plaque (VP), vulnerable blood and the vulnerable patient. This 'state of the art' review discusses the limitations of coronary angiography alone in providing risk assessment; reviews the underlying biological concepts of VP; discusses evolving noninvasive and invasive imaging technologies for the detection of VP; and finally provides a futuristic look at how the field of interventional cardiology may transcend the traditional angiogram and move toward a more comprehensive treatment approach that benefits the patients' overall coronary health.
Young
John J
JJ
Swedish Heart and Vascular Institute, Seattle, Washington 98122, USA. johnj.young@swedish.org
Phillips
Harry R
HR
Marso
Steven P
SP
Granada
Juan F
JF
McPherson
John A
JA
Waksman
Ron
R
Steinhubl
Steven R
SR
Schwartz
Robert S
RS
Stone
Gregg W
GW
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D050197:Atherosclerosis; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003952:Diagnostic Imaging / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013057:Spectrum Analysis / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional