Understanding Vulnerable Plaques: Current Status and Future Directions

The main cause of acute myocardial infarction is plaque rupture accompanied by superimposed coronary thrombosis. Thin-cap fibroatheromas (TCFAs) have been suggested as a type of lesion with a vulnerability that can cause plaque rupture. However, not only the existence of a TCFA but also the fine and complex interactions of other anatomical and hemodynamic factors, such as microcalcification in the fibrous cap, cholesterol crystal-induced inflammasome activation, the apoptosis of intraplaque macrophages, and endothelial shear stress distribution should precede a clinical event caused by plaque rupture. Recent studies are being conducted to identify these mechanisms through molecular imaging and hemodynamic assessment using computational fluid dynamics, which will result in better clinical results through selective coronary interventions.

Intravascular optical coherence tomography in detecting vulnerable coronary plaque: An update / 第二军医大学学报

Rupture of a vulnerable plaque and the subsequent thrombus formation are the main cause of acute coronary syndrome (ACS). The key to avoid clinical cardiology event is the early detection and prompt management of vulnerable plaques. Many imaging modalities have been introduced to identify thin-capped fibroatheroma (TFCA), but the morphology and the mechanism of vulnerable plaque rupture are still great concern of clinicians. Intravascular optical coherence tomography (OCT) is an examination based on cardiac catheter. tt uses near-infrared light to obtain up to 10 μm high-resolution mages, to display the in vivo micro-structure of blood vessll wall. With the development of a new generation of frequency-domain OCT (FD-OCT), OCT will play an active role in TCFA. We reviewed here the studies of TCFA involving OCT.