Abstract
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging.
Highlights
Despite significant advancements in pharmacological and interventional management, coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide [1, 2]
Longestablished as the gold standard to evaluate the presence, location and extent of stenosis associated with CAD, invasive coronary angiography provides a two-dimensional representation of the coronary lumen but is incapable of visualising the composition of the atherosclerotic plaque [3]
The purpose of this review is to provide a critical overview of the applications of in vivo intracoronary imaging techniques, in the identification of high-risk, vulnerable atherosclerotic plaques
Summary
Despite significant advancements in pharmacological and interventional management, coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide [1, 2]. The thin-cap fibroatheroma (TCFA) represents a specific morphology of vulnerable plaque, characterised by a thin fibrous layer overlying a large core of lipid-rich necrotic debris and associated with expansive arterial remodelling [13, 14]. IVUS permits detailed evaluation of the coronary artery lumen, wall and plaque area and enables both qualitative and quantitative and pre- and post-intervention assessment of lesion morphology, to a depth of 5–10 mm, with an axial spatial resolution of 100–200 μm at frequencies ranging from 20 to 45 MHz. The IVUS catheter is mounted to an automated pullback device, which withdraws the catheter at a pre-set speed (e.g. 0.5 mm s−1), enabling the acquisition of a cylinder, representative of a length of an artery.
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