Abstract
Recently, there has been a growing interest in identification of coronary “vulnerable plaques” that are prone to rupture; this potentially would help identify patients with higher risk of development of cardiac events. Recent advances in cardiac imaging modalities have been successful in studying various plaque vulnerability features to variable degrees, strengths and limitations. Computed Tomography Coronary Angiography (CTCA) has gained an increasing popularity in studying plaque anatomy, morphology and composition by the virtue of its widespread availability and non-invasiveness. CTCA has been validated against histology and IVUS with reasonable correlation; moreover, some follow-up studies have shown a significant association to the development of acute coronary syndromes. Nevertheless, attention should be paid to the whole patient big picture that includes other factors operating on other extra-coronary axes that involve inflammation, immunity, coagulation and neuroendocrine systems.
Highlights
Atherosclerotic cardiovascular diseases are still the leading cause of deaths in industrialized Countries and Coronary Artery Disease (CAD) accounts for the majority of this toll [1]
Cardiac events are typically caused by disruption of coronary plaques where plaque rupture occurs in about two thirds of cases, while the remaining third of cases are caused by plaque erosion with subsequent formation of occluding thrombus [2]
Motoyama et al [35] calculated the remodeling index and reported positive remodeling when the diameter at the plaque site was at least 10% larger than reference segment, it was shown that the frequency of positive remodeling among patients with acute coronary syndrome (ACS) was significantly higher than those with stable angina (87% Vs. 12%, P
Summary
Atherosclerotic cardiovascular diseases are still the leading cause of deaths in industrialized Countries and Coronary Artery Disease (CAD) accounts for the majority of this toll [1]. The histopathological features that have been associated with vulnerable plaques and defined them, include: 1) A large eccentric necrotic lipid core, occupying approximately one-quarter of the plaque area [3], 2) A thin fibrous cap (
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