This article provides a systematic approach to vulnerable plaques. It is divided into 4 sections. The first section is devoted to definition, incidence, anatomic distribution, and clinical presentation. The second section is devoted to plaque composition, setting up the foundations to understand plaque vulnerability. The third section relates to invasive plaque imaging. The fourth section is devoted to therapy, from conservative pharmacologic options to aggressive percutaneous coronary intervention alternatives.
[Show abstract][Hide abstract] ABSTRACT: The basic pathohistological substrate of vascular complications is atherosclerotic plaque and, therefore, the adequate treatment of patients with vascular disease is conditioned by timely and precise diagnosis. The introduction of ultrasound technology in clinical practice was enabled by Edler and Hertz in 1954, when they presented the myocardial motions, then by Yoshida in 1956, Sotomura in 1959, and Frenklin in 1961, who used ultrasound to display the blood flow in the human blood vessels. The aim of our study was to determine the incidence and vulnerability of plaques in the carotid arteries and to examine the association between plaque vulnerability and visceral fat thickness in patients with diabetes mellitus type 2. The investigation involved 82 subjects divided into two groups. The first group included 51 subjects suffering from diabetes mellitus type 2, while the second group involved 31 healthy controls. Among the examinees, a significantly higher incidence of plaque vulnerability was reported in the patients suffering from diabetes melitus type 2. Average thickness of intraabdominal fatty tissue was significantly higher in the patients with diabetes mellitus type 2 compared to controls. The incidence of vulnerable plaques significantly correlated with diabetes mellitus incidence and thickness of intraabdominal fatty tissue. Visceral obesity and diabetes mellitus type 2 showed significant association with atherosclerosis. Ultrasound determination of carotid stenosis and intraabdominal fatty tissue thickness are the most important criteria for classification of patients with high risk of ischemic stroke.
[Show abstract][Hide abstract] ABSTRACT: An estimated 16 million people in the United States have coronary artery disease (CAD), and approximately 325,000 people die annually from cardiac arrest. About two-thirds of unexpected cardiac deaths occur without prior recognition of cardiac disease. A vast majority of these deaths are attributable to the rupture of 'vulnerable atherosclerotic plaques'. Clinically, plaque vulnerability is typically assessed through imaging techniques, and ruptured plaques leading to acute myocardial infarction are treated through angioplasty or stenting. Despite significant advances, it is clear that current imaging methods are insufficiently capable for elucidating plaque composition-which is a key determinant of vulnerability. Further, the exciting improvement in the treatment of CAD afforded by stenting procedures has been buffered by significant undesirable host-implant effects, including restenosis and late thrombosis. Nanotechnology has led to some potential solutions to these problems by yielding constructs that interface with plaque cellular components at an unprecedented size scale. By leveraging the innate ability of macrophages to phagocytose nanoparticles, contrast agents can now be targeted to plaque inflammatory activity. Improvements in nano-patterning procedures have now led to increased ability to regenerate tissue isotropy directly on stents, enabling gradual regeneration of normal, physiologic vascular structures. Advancements in immunoassay technologies promise lower costs for biomarker measurements, and in the near future, may enable the addition of routine blood testing to the clinician's toolbox-decreasing the costs of atherosclerosis-related medical care. These are merely three examples among many stories of how nanotechnology continues to promise advances in the diagnosis and treatment of vulnerable atherosclerotic plaques.
[Show abstract][Hide abstract] ABSTRACT: The goal of this study was to evaluate the diagnostic value of postmortem multi-computed tomography (MDCT) and MDCT-angiography for sudden cardiac deaths related to ischemic heart disease. Twenty three cases were selected based on clinical history and the results of native MDCT, multiphase post-mortem CT-angiography and conventional autopsy were compared. Radiological examination showed calcification of coronary arteries in 78% of the cases, most of which were not detailed at autopsy. MDCT-angiography allowed better visualization of the coronary arteries than MDCT and permitted the evaluation of stenoses and occlusions. Of the 14 cases of coronary thrombosis detected at conventional autopsy, 11 were visible as stop of perfusion with CT-angiography and three were found to be partly perfused. One case had an old thrombosis with collateral circulation. One case had a coronary artery postmortem clot found with MDCT-angiography. Coronary artery calcifications are more easily detected and documented with radiological examination than with conventional autopsy. MDCT is of limited diagnostic value for ischemic heart disease. MDCT-angiography, when correctly interpreted, is a reasonable tool to view the morphology of coronary arteries, rule out significant coronary artery stenoses, identify occlusions and direct sampling for histological examination.
The international journal of cardiovascular imaging 01/2012; 28(7):1807-22. DOI:10.1007/s10554-012-0012-x · 1.81 Impact Factor
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