Plaque Characteristics Research Articles

Quantitative Plaque Characteristics/Pericoronary Fat Attenuation Index and Acute Coronary Syndrome in Patients With Stable Angina Pectoris.

Vascular inflammation affects acute coronary syndrome (ACS) occurrence in patients with stable angina. Coronary inflammation can be represented by the pericoronary fat attenuation index (FAI).This study investigated the quantitative prognostic value of plaque characteristics and FAI in patients with stable angina. Risk factors for ACS occurrence in patients with stable angina pectoris were retrospectively analyzed. The diagnostic value of FAI and plaque characteristics for ACS occurrence in these patients were determined; Kaplan-Meier curves were used to predict ACS event incidence. After postpropensity score matching, data of 60 and 130 patients with and without ACS, respectively, were analyzed. Pericoronary FAI, lipid volume, and lipid percentage in the narrowest segment significantly improved ACS diagnosis in patients with stable angina. Luminal stenosis ≥50% and FAI >-88 Hounsfield units (HU) were independent risk factors for ACS occurrence in patients with stable angina. Perileft anterior descending artery (LAD) FAI >-88HU better predicted ACS occurrence in patients with stable angina than did peri-LAD FAI ≤-88HU. In patients with stable angina, lipid volume and percentage and pericoronary FAI improved the diagnostic ability of luminal stenosis for ACS occurrence. Furthermore, peri-LAD FAI >-88HU could predict ACS occurrence.

Coronary CT Angiography in the Emergency Department: State of the Art and Future Perspectives

About 5% of annual access to emergency departments (EDs) and up to 25–30% of hospital admissions involve patients with symptoms suggestive of acute coronary syndrome (ACS). The process of evaluating and treating these patients is highly challenging for clinicians because failing to correctly identify an ACS can result in fatal or life-threatening consequences. However, about 50–60% of these patients who are admitted to the hospital because of chest pain are found to have no ACS. Coronary computed tomographic angiography (CCTA) has emerged as a proposed new frontline test for managing acute chest pain in the ED, particularly for patients with low-to-intermediate risk. This narrative review explores the potential of adopting an early CCTA-based approach in the ED, its significance in the era of high-sensitivity troponins, its application to high-risk patients and its prognostic value concerning atherosclerotic burden and high-risk plaque features. Additionally, we address clinical and technical issues related to CCTA use for triaging acute chest pain in the ED, as well as the role of functional testing. Finally, we aim to provide insight into future perspectives for the clinical application of CCTA in the ED.

Composite cardiac computed tomography angiography score for improved risk assessment in chronic coronary syndromes

Agatston score, the degree of lumen narrowing categorized by CAD-RADS, high-risk atherosclerotic plaque features and pericoronary adipose tissue attenuation (PCAT) are parameters, which can be assessed non-invasively by coronary computed tomography angiography (CCTA) and aid risk stratification in patients with chronic coronary syndromes (CCS). However, few studies have so far compared the prognostic value of all those parameters together. To develop and test the prognostic value of a composite CCTA score, derived from Agatston score, CAD-RADS, high-risk plaques and PCAT in patients undergoing CCTA due to CCS. Consecutive patients with clinical indication for CCTA and available clinical follow-up of ≥ 6 months after the CCTA examination were included. (i) Agatston score, (ii) CAD-RADS, (iii) the number of plaques with at least one high-risk feature and (iv) PCAT in the proximal 4 cm of the right coronary artery (RCA) were measured, and a composite CCTA score was generated considering all four parameters. The primary endpoint encompassed all-cause mortality, myocardial infarction, and coronary revascularization (> 60 days after the CCTA scan) during follow-up. In total, 759 patients (median age 68.0 (IQR 59.0–76.0) years, 352 (46.4%) female) were included. During a median follow-up of 591.5 (IQR 505.5-686.8) days, 39 (5.1%) patients reached the primary endpoint. Cox-proportional regression demonstrated that the Agatston score, the number of high-risk plaques and CAD-RADS predicted the primary endpoint, independent of age and conventional cardiovascular risk factors. The number of high-risk plaques per patient provided the most robust prediction of the primary endpoint (HR = 2.74, 95%CI = 1.56–4.80, p < 0.001), whereas the composite CCTA score outperformed all other parameters (HR = 1.54, 95%CI = 1.19–1.98, p < 0.001). The Agatston score, CAD-RADS and high-risk plaque features may provide complementary prognostic information in patients with CCS. A composite CCTA score, derived by these imaging markers may identify high-risk individuals, who may benefit from more intensified treatment and clinical follow-up in future studies.

What have we learnt from histology about the efficacy of coronary imaging modalities in assessing plaque composition?

Accurate evaluation of coronary artery pathology is essential for risk stratification and tailoring appropriate treatment. Intravascular imaging was introduced for this purpose 40 years ago enabling for the first time in vivo plaque characterization. Since then, several studies have evaluated the efficacy of the existing intravascular imaging modalities in assessing plaque pathology and composition and their potential in guiding intervention and predicting vulnerable plaques. Today it is known that intravascular imaging is an indispensable tool in percutaneous coronary intervention planning, but the existing modalities have a limited efficacy in predicting lesion vulnerability; a fact that should be attributed to their advantages and limitations in accurately assessing morpho-pathological features that are common in advanced atherosclerotic plaques. This review aims to provide a comprehensive evaluation of the performance of intravascular imaging in characterizing plaque phenotypes using histology as a reference standard; it summarizes the studies comparing the available invasive imaging techniques against histology, discusses the findings and limitations of these studies and highlights the potential of novel intravascular imaging approaches that were introduced for a more complete and comprehensive evaluation of plaque pathobiology.

Targeting Interleukin-6 Signaling with Tocilizumab in Atherosclerosis: A Meta-Analysis of Anti-Inflammatory Effects and Plaque Stabilization

Atherosclerosis, a chronic inflammatory disease, is the leading cause of cardiovascular disease. Interleukin-6 (IL-6) plays a crucial role in atherogenesis, making it a potential therapeutic target. Tocilizumab, an IL-6 receptor antagonist, has shown promise in reducing inflammation and stabilizing atherosclerotic plaques. This meta-analysis aimed to evaluate the efficacy and safety of tocilizumab in atherosclerosis by analyzing its impact on inflammatory markers and plaque characteristics. A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to January 2024. Studies evaluating the effects of tocilizumab on inflammatory markers and plaque characteristics in patients with atherosclerosis were included. Randomized controlled trials (RCTs) and observational studies with a comparative arm were eligible. Data were extracted and pooled using a random-effects model. Nine studies (n=1248 participants) met the inclusion criteria. Tocilizumab significantly reduced CRP levels (standardized mean difference [SMD] -1.23; 95% confidence interval [CI] -1.56 to -0.90; p&lt;0.001) and IL-6 levels (SMD -0.87; 95% CI -1.12 to -0.62; p&lt;0.001) compared to control groups. A significant reduction in plaque volume (SMD -0.45; 95% CI -0.71 to -0.19; p=0.001) and an increase in fibrous cap thickness (SMD 0.38; 95% CI 0.12 to 0.64; p=0.004) were also observed. No significant increase in adverse events was reported in the tocilizumab group. This meta-analysis demonstrates that tocilizumab effectively reduces inflammation and promotes plaque stabilization in atherosclerosis. These findings suggest that tocilizumab may be a promising therapeutic strategy for preventing cardiovascular events in patients with atherosclerosis. Further large-scale RCTs are needed to confirm these findings and establish the long-term safety and efficacy of tocilizumab in this population.

MODERN POSSIBILITIES OF USING ARTIFICIAL INTELLIGENCE TECHNOLOGIES IN CARDIOVASCULAR IMAGING

Cardiovascular diseases (CVD) are the leading cause of morbidity, disability and mortality worldwide. The emergence of new technologies and the introduction of artificial intelligence (AI) and machine learning (ML) have opened up opportunities for doctors to improve the effectiveness of diagnostic and therapeutic measures. The exponential development of AI, mainly in the fields of MO and deep learning (DL), is rapidly attracting the interest of clinicians in creating new integrated, reliable and effective methods of medical care. Cardiologists use a wide range of imaging-based diagnostic measures, which gives them access to more extensive quantitative information about patients compared to many other specialties. The purpose of the review is to summarize current literature data on the use of AI in the diagnosis of CVD, as well as to identify knowledge gaps that require further research. Cardiology is one of the fields of medicine where the methods of ML and DL have become widespread and have shown promising results. In echo-CG, SNN were successfully used to measure parameters of cardiac function. In cardiac CT, DL algorithms contributed to more accurate detection of coronary artery stenosis and calcification (CCA), and determination of plaque characteristics. In MRI, CNTs were used to solve problems such as automatic segmentation of chambers and structures of the heart, determination of tissue properties and perfusion analysis. As AI and MO technologies evolve, their integration opens up new opportunities. AI technologies are of great interest in the healthcare sector, due to the ability to analyze vast amounts of information in a short time, demonstrating high efficiency. AI can be an additional help to specialists, contributing to an increase in the efficiency of the workflow and medical care.

High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study

Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with IGT and normal glucose tolerance (NGT) in patients suspected for stable CAD. Coronary computed tomography angiography (CCTA) identified LAP lesions and assessed plaque volumes, burdens, and high-risk plaque features. Glycemic tolerance was stratified using oral glucose tolerance tests. Among 148 patients, 202 LAP lesions were identified, with 93 patients classified as NGT and 55 as IGT. Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (p = 0.007). LAP volume was higher in IGT (16.46 ± 12.52 mm3) compared with NGT (12.66 ± 9.72 mm3, p = 0.01), but this association did not persist in multivariate analysis. The LAP burden was greater in IGT (10.79 ± 6.84%) than NGT (8.62 ± 5.93%, p = 0.02), and the napkin-ring sign was more frequent in IGT (12%) versus NGT (5%, p = 0.02); these associations remained significant in multivariate analysis. Patients with IGT had a higher LAP burden and higher frequency of napkin-ring signs. These findings may help explain the common occurrence of prediabetes in patients with acute myocardial infarction.

Differentiation of Atherosclerotic Carotid Plaque Components With Dual-Energy Computed Tomography.

Carotid plaque vulnerability is a strong predictor of recurrent ipsilateral stroke, but differentiation of plaque components using conventional computed tomography (CT) is suboptimal. The aim of our study was to evaluate the ability of dual-energy CT (DECT) to characterize atherosclerotic carotid plaque components based on the effective atomic number and effective electron density using magnetic resonance imaging (MRI) and, where possible, histology as the reference standard. Patients with recent cerebral ischemia and a ≥2-mm carotid plaque underwent computed tomography angiography and MRI. A subgroup underwent carotid endarterectomy. Trained observers delineated plaque components on histology or MRI, independent of computed tomography angiography. DECT was coregistered with MRI and/or histology. Intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous tissue, and calcifications were delineated on DECT, and ρeff and Zeff values were determined in the derivation cohort (n = 55). Spatial separation of these components was evaluated in a ρeff-Zeff-cluster plot. Ranges that optimally differentiate plaque features were determined. For validation, plaque components were quantified in the validation cohort (n = 29) using these ρeff-Zeff ranges and literature-based Hounsfield unit (HU) ranges and correlated to MRI volumes. Eighty-four participants (68 ± 8 years; 55 male) were evaluated. In the derivation cohort, plaque components were well separated on the cluster plot, resulting in the following ranges: IPH:ρeff < 1.15, Zeff < 7.5, LRNC:ρeff < 1.15, Zeff:7.5-8.75, fibrous tissue:ρeff < 1.15, Zeff > 8.75, and calcifications: ρeff > 1.15, Zeff > 0. In the validation cohort, significant correlations were found between ρeff-Zeff-based and MRI plaque volumes for fibrous tissue (r = 0.69, P < 0.001), LRNC (r = 0.94, P < 0.001), IPH (r = 0.35, P = 0.03), and calcifications (r = 0.70, P < 0.001). Lower correlations were found between HU-based and MRI plaque volumes for fibrous tissue (r = 0.40, P = 0.02), LRNC (r = 0.86, P < 0.001), and calcifications (r = 0.47, P = 0.005), with no correlation for IPH (r = 0.02, P = 0.45). We determined ρeff-Zeff ranges for plaque assessment. ρeff-Zeff-based volumes showed strong-to-very strong correlations with MRI for LRNC, fibrous tissue, and calcifications and a weak correlation for IPH. ρeff-Zeff-based volumes demonstrated superior agreement with MRI for all plaque components compared with HU-based volumes, highlighting the potential of DECT for the identification of patients with vulnerable plaques.

Prevalence of Carotid Plaques with High-risk Features in Embolic Stroke of Undetermined Source: Systematic Review and Meta-Analysis.

Recent evidence suggests a possible role of non-stenotic carotid atherosclerotic plaques in the aetiology of embolic stroke of undetermined source (ESUS). We conducted a systematic review and meta-analysis of prevalence and characteristics of non-stenotic carotid plaques (NSP) with high-risk features (complicated NSP) in internal carotid artery in unilateral ESUS in the anterior circulation. We searched Medline and Ovid-Embase databases. High-risk features were intra-plaque haemorrhage, thickness ≥ 3 mm, ulceration and hypodensity. We assessed the risk-of-bias (RoB), extracted the data, calculated the pooled-prevalence and 95% confidence intervals using Inverse Variance Weighting method and Random Effect models. We included 16 studies and 1406 patients with different imaging for NSP assessment (1 Ultrasound, 11 CT-angiography, 4 MR-angiography). The RoB was moderate to low in most studies. Definition of complicated NSP differed across studies. The combined prevalence of any complicated NSP was 31% (95% CI=27-36%) ipsilateral and 14% (95%CI=9-19%) contralateral to the index stroke, the finding of any high-risk NSP was four-fold higher ipsilateral to the index stroke (OR=3.63; 95%CI=2.09-6.33). Prevalence of single high-risk features ipsilateral to ESUS was as follows: 35% (95%CI= 30-41%) for thickness ≥ 3 mm; 24% (95%CI= 8-39%) for ulceration; 45% (95%CI= -2; 93%) for hypodensity, 16% (95%CI=5-26%) for intraplaque haemorrhage. Complicated NSP are present in around a third of all ESUS, and are four times more frequent ipsilaterally to the index stroke. Our results confirm the possible causal role in ESUS and highlight the need for greater diagnostic uniformity of plaque at risk.

Potential of low apolipoprotein A-I as a surrogate marker of vulnerable carotid artery plaques.

Recent studies suggested that the medical control of atherogenic lipoproteins is not sufficient for stroke prevention. A low apolipoprotein A-I (apoA-I) level may play a crucial role in the anti-atherogenic effects of high-density lipoprotein (HDL-C) and may also be associated with symptomatic vulnerable plaques in carotid artery stenosis. Therefore, the present study investigated the relationship between apoA-I levels and the status of carotid artery stenosis. Ninety-one patients with carotid artery stenosis were examined. The status of carotid artery plaques was divided into symptomatic (n= 47) and asymptomatic (n= 44). We examined patient profiles, including comorbidities, and laboratory lipid data, and plaque features visualized by ultrasonography, MRI, and digital subtraction angiography. The relationships between plaque instability and risk factors for carotid artery stenosis were investigated. No significant differences were observed in the profiles of symptomatic and asymptomatic patients. Regarding plaque features, ulceration, low echo luminance, and a high signal intensity in plaques on T1-weighted images correlated with symptomatic plaques. ApoA-I, total cholesterol, and non-HDL-C levels were significantly lower in symptomatic patients than in asymptomatic patients. A multivariate logistic regression analysis identified low ApoA-I levels, ulceration, and low echo luminance as predictive factors for symptomatic carotid artery stenosis. Diagnostic accuracy for predicting symptomatic carotid stenosis was 0.84 when the following four factors were combined: ulceration, low echo luminance, a high signal intensity on T1-weighted images, and the level of apoA-I. A low apoA-I level was associated with symptomatic carotid artery stenosis. Therefore, ApoA-I levels have potential as a surrogate marker to detect unstable carotid artery plaques.

Correlation of intracranial and extracranial carotid atherosclerotic plaque characteristics with ischemic stroke recurrence: a high-resolution vessel wall imaging study

ObjectivesTo evaluate the ability of the plaque characteristics of extracranial carotid and intracranial arteries to predict large atherosclerotic ischemic stroke recurrence via head and neck combined high-resolution vessel wall imaging (HR-VWI).MethodsThis prospective cohort study included 169 patients with large atherosclerotic ischemic stroke who underwent head and neck combined HR-VWI from April 2022 to May 2023. The baseline clinical data and atherosclerotic plaque characteristics of the intracranial and extracranial carotid arteries were collected, and the patients were followed up for 1 year, with the endpoint event defined as recurrent ischemic stroke. Clinical and imaging data were compared between the recurrent and nonrecurrent groups. Independent risk factors associated with stroke recurrence were assessed via multivariate Cox regression analysis. The receiver operating characteristic (ROC) curves of the relevant variables were also plotted, and the area under the curve (AUC) was calculated to assess their ability to predict stroke recurrence. Kaplan–Meier survival curves were used to compare the probability of stroke recurrence.ResultsDuring the 12-month follow-up, stroke recurrence occurred in 35 of the 169 patients. Multivariate Cox regression analysis revealed that the total number of intracranial and extracranial carotid plaques (p = 0.010) and coexisting extracranial carotid plaques and intracranial significantly enhanced plaques (p = 0.047) were independent risk factors for recurrent ischemic stroke. The AUCs for predicting stroke recurrence were 0.787 and 0.710, respectively. The Kaplan–Meier survival curve revealed that the risk of stroke recurrence was significantly greater in patients whose total number of intracranial and extracranial carotid plaques was &amp;gt;4.5 than in patients whose total number of plaques was &amp;lt;4.5 (p &amp;lt; 0.001) and was significantly greater in patients with coexisting extracranial carotid plaques and intracranial significantly enhanced plaques than in patients without coexisting plaques (p &amp;lt; 0.001).ConclusionA greater total number of intracranial and extracranial carotid plaques and the coexistence of extracranial carotid plaques and intracranially significantly enhanced plaques are independent risk factors associated with recurrent ischemic stroke. Head and neck combined HR-VWI may provide new indicators for the prediction of stroke recurrence, thus helping clinicians identify high-risk patients and target therapy to reduce the recurrence of ischemic events.

Carotid artery atherosclerosis: mechanisms of instability and clinical implications.

Cardiovascular disease remains a prominent cause of disability and premature death worldwide. Within this spectrum, carotid artery atherosclerosis is a complex and multifaceted condition, and a prominent precursor of acute ischaemic stroke and other cardiovascular events. The intricate interplay among inflammation, oxidative stress, endothelial dysfunction, lipid metabolism, and immune responses participates in the development of lesions, leading to luminal stenosis and potential plaque instability. Even non-stenotic plaques can precipitate a sudden cerebrovascular event, regardless of the degree of luminal encroachment. In this context, carotid imaging modalities have proved their efficacy in providing in vivo characterization of plaque features, contributing substantially to patient risk stratification and clinical management. This review emphasizes the importance of identifying high-risk individuals by use of current imaging modalities, biomarkers, and risk stratification tools. Such approaches inform early intervention and the implementation of personalized therapeutic strategies, ultimately enhancing patient outcomes in the realm of cardiovascular disease management.

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial.

Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial. Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. Images of 1769 patients were assessed (56​% male, 58​±​9 years). Diabetes mellitus was present in 196 (11​%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p​<​0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p​<​0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p​=​0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95​% confidence interval 1.09 to 3.17, p​=​0.024). Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.

Prognostic Value of Serum TMAO Measurement in Patients with STEMI: A Systematic Literature Review.

Gut microbiota-derived metabolite Trimethylamine-N-oxide (TMAO) is increasingly recognized as a potential novel prognostic biomarker for cardiovascular disease. Our research work aimed to investigate the potential utility of TMAO measurement in patients with STelevation Myocardial Infarction (STEMI). We performed a systematic literature search in PubMed from inception to the 1st of February 2024 to identify all studies examining the association between plasma TMAO levels and disease complexity or clinical outcomes in STEMI patients. A total of eight prospective cohort studies were included, encompassing a total of 2,378 STEMI patients. Three of the studies provided only in-hospital evidence (i.e., increased odds for more severe coronary artery disease, plaque rupture, and plaque healing in patients with increased TMAO levels). Four studies examined the long-term prognostic value of TMAO after 10-12 months of follow-up post-STEMI (i.e., increased risk of adverse cardiovascular events in patients with increased TMAO levels), while one study provided data for both in-hospital and mid-term prognosis, indicating that 4-months after STEMI patients with greater TMAO elevation had larger infarct size. Higher TMAO levels were associated with a greater prevalence of high-risk coronary plaque characteristics and worse in-hospital and follow-up outcomes in STEMI patients. Further study is needed on whether modulating the diet-dependent TMAO levels could improve clinical outcomes in these patients. [(OSF): https://doi.org/10.17605/OSF.IO/WNG8V].

Evaluating the Influence of Morphological Features on the Vulnerability of Lipid-Rich Plaques During Stenting.

Lipid-rich atheromas are linked to plaque rupture in stented atherosclerotic arteries. While fibrous cap thickness is acknowledged as a critical indicator of vulnerability, it is likely that other morphological features also exert influence. However, detailed quantifications of their contributions and intertwined effects in stenting are lacking. Therefore, our goal is to assess the impact of plaque characteristics on the fibrous cap stress and elucidate their underlying mechanisms. We analyzed the stent deployment in a three-dimensional patient-specific coronary artery reconstructed from intravascular optical coherence tomography (IVOCT) data using the finite element method. Additionally, we performed sensitivity analysis on 78,000 distinct plaque geometries of two-dimensional arterial cross section for verification. Results from the three-dimensional patient-specific model indicate strong correlations between maximum fibrous cap stress and lipid arc (r=0.769), area stenosis (r=0.550), and lumen curvature (r=0.642). Plaques with lipid arcs >60 deg, area stenosis >75%, and lumen curvatures >5 mm-1 are at rupture risk. While we observed a rise in stress with thicker lipid cores, it was less representative than other features. Fibrous cap thickness showed a poor correlation, with the sensitivity analysis revealing its significance only when high stretches are induced by other features, likely due to its J-shaped stress-stretch response. Contrary to physiological pressure, the stent expansion generates unique vulnerable features as the stent load-transferring characteristics modify the plaque's response. This study is expected to prompt further clinical investigations of other morphological features for predicting plaque rupture in stenting.

Macrophage-based pathogenesis and theranostics of vulnerable plaques.

Vulnerable plaques, which are high-risk features of atherosclerosis, constitute critical elements in the disease's progression due to their formation and rupture. Macrophages and macrophage-derived foam cells are pivotal in inducing vulnerability within atherosclerotic plaques. Thus, understanding macrophage contributions to vulnerable plaques is essential for advancing the comprehension of atherosclerosis and devising novel therapeutic and diagnostic strategies. This review provides an overview of the pathological characteristics of vulnerable plaques, emphasizes macrophages' critical role, and discusses advanced strategies for their diagnosis and treatment. It aims to present a comprehensive macrophage-centered perspective for addressing vulnerable plaques in atherosclerosis.

Predicting plaque regression based on plaque characteristics identified by optical coherence tomography: A retrospective study.

Atherosclerosis is a lipid-driven, systemic immune-inflammatory disease characterized by the accumulation of plaque within the arterial walls. Plaque regression can occur following appropriate treatment interventions. Optical coherence tomography (OCT), a high-resolution imaging modality, is frequently employed to assess plaque morphology. This study aims to explore the correlation between plaque characteristics identified using OCT, particularly macrophage infiltration, and subsequent plaque regression. In this retrospective study, data from 112 individuals with coronary artery plaques, who underwent OCT imaging at our hospital, between June 2019 and June 2024, were evaluated. Plaques were classified as lipid-rich, fibrous, or calcified based on the initial OCT findings. Macrophage infiltration levels within each plaque type were quantified. After one year of follow-up, repeat OCT imaging was performed to evaluate plaque regression. Statistical analyses were conducted to assess the relationship between initial plaque characteristics and regression outcomes. Plaques that underwent regression were more commonly lipid-rich and exhibited higher levels of macrophage infiltration compared to those without regression. Multivariate analysis identified the histological inflammation score (HIS) as an independent factor influencing plaque regression. Macrophage-rich plaques, as detected by OCT, are significant predictors of plaque regression. The identification of vulnerable plaque features through OCT can enhance the early diagnosis and treatment strategies for atherosclerotic cardiovascular disease.

Characteristics of Coronary Artery Vulnerable Plaque on Coronary Computed Tomography Angiography (CCTA) and Optical Coherence Tomography (OCT) - A Review Article

Characteristics of Coronary Artery Vulnerable Plaque on Coronary Computed Tomography Angiography (CCTA) and Optical Coherence Tomography (OCT) - A Review Article

Coronary plaque characteristics quantified by artificial intelligence-enabled plaque analysis: Insights from a multi-ethnic asymptomatic US population

Coronary plaque characteristics quantified by artificial intelligence-enabled plaque analysis: Insights from a multi-ethnic asymptomatic US population

Clinical and Carotid Plaque Features in Symptomatic and Asymptomatic Ischemic Stroke.

Aims/Background Ischemic stroke (IS), a cerebrovascular condition, is commonly detected by evaluating carotid intima-media (CIA) stenosis. Symptomatic CIA stenosis carries a high risk (up to 32%) of another ischemic event within 12 weeks, while asymptomatic CIA stenosis has an annual risk ranging from 1% to 2%. Therefore, this study aims to explore the diagnostic value of clinical features and carotid plaque characteristics in both symptomatic and asymptomatic IS. Methods This study enrolled 543 consecutive patients with internal carotid artery stenosis confirmed by carotid ultrasonography. Participants were categorized into the symptomatic group (n = 356) and the asymptomatic group (n = 187) by clinical symptoms and computed tomography (CT)/magnetic resonance imaging (MRI) of the brain. Demographic data, clinical features, and ultrasonographic characteristics of the carotid plaque were collected, and logistics regression analysis was carried out to explore the predictive risk factors of IS. Results According to the differences in clinical and carotid plaque characteristics between the two groups, coronary heart disease (CHD), stenosis degree, plaque diameter, plaque length, plaque vulnerability, and plaque echo type were included. The results of the multivariate logistics regression analysis showed that plaque vulnerability, CHD, and plaque hypoechogenicity were independent predictors of symptomatic stroke. The clinical-ultrasonographic prediction model showed an area under the curve (AUC) of 0.85 [95% confidence interval (CI): 0.82-0.88], a sensitivity of 0.74 (95% CI: 0.69-0.78), and a specificity of 0.81 (95% CI: 0.76-0.87), with a good performance in the model prediction. Conclusion Plaque vulnerability, CHD, and plaque hypoechogenicity are meaningful predictors of symptomatic ischemic stroke and deserve attention in the future.