Abstract
The term “vulnerable plaque” is commonly used to refer to an atherosclerotic plaque that is prone to rupture and the formation of thrombosis, which can lead to several cardiovascular and cerebrovascular events. Coronary artery atherosclerosis has a wide variety of different phenotypes among patients who may have a substantially variable risk for plaque rupture and cardiovascular events. Mounting evidence has proposed three distinctive histopathological mechanisms: plaque rupture, plaque erosion and calcified nodules. Studies have demonstrated the characteristics of plaques with high vulnerability such as the presence of a thin fibrous cap, a necrotic lipid-rich core, abundant infiltrating macrophages and neovascularization. However, traditional coronary angiographic imaging fails to determine plaque vulnerability features, and its ability to individualize treatment strategies is limited. In recent decades, catheter-based intravascular ultrasound imaging (IVUS) modalities have been developed to identify vulnerable plaques and ultimately vulnerable patients. The aim is to individualize prediction, prevention and treatment of acute coronary events based on the identification of specific features of high-risk atherosclerotic plaques, and to identify the most appropriate interventional procedures for their treatment. In this context, the aim of this review is to discuss how personalized assessment of coronary atherosclerotic arteries can be achieved by intravascular ultrasound imaging focusing on vulnerable plaque detection.
Highlights
Cardiovascular diseases are the number one cause of death worldwide, and the most frequent is coronary artery disease (CAD)
The presence related to plaque rupture, composed primarily of largehave calcification deposits are considered of microcalcification in theplaques fibrous cap and spotty calcification been related to plaque rupture, to be more stable plaques composed primarily of large calcification deposits are considered to be more stable [13,14,15,16]
Rupture of the atherosclerotic plaque associated with small minimum lumen area (MLA) and thrombus formation usually causes symptoms, whereas plaque rupture without symptoms is associated with the formation of scar tissue and the progression of atherosclerotic lesion
Summary
Cardiovascular diseases are the number one cause of death worldwide, and the most frequent is coronary artery disease (CAD). Acute coronary syndrome (ACS), a common complication of coronary artery disease, is a term used to describe a range of conditions where the blood supply to any part of the heart is suddenly reduced or blocked. The source of the majority of ACS cases is the erosion or rupture of an atherosclerotic plaque, which leads to the development of intraluminal thrombus that can further limit, or even block, the blood flow. Measurement, near-infrared spectroscopy and so on, the present review aims to provide a brief overview assessing coronary atherosclerosis and plaque vulnerability by intravascular ultrasound (IVUS) imaging. We aim to highlight the contribution of IVUS in making the diagnosis of coronary atherosclerosis severity, and risk of coronary events, more precise by detecting plaque features that could not otherwise be assessed by traditional, routine angiographic examination (still the gold-standard method for coronary artery examination).
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