Lipidrich necrotic core plaque is shown in red representing 24% of the total plaque volume. Triggers, acute risk factors and vulnerable plaques. In an in vitro study, it was demonstrated that sensitivity and specificity of elastography to detect vulnerable plaques are 88% and 89%, respectively. Identification of patients and plaques vulnerable to future. In this regard, coronary computed tomography ct angiography is an attractive noninvasive imaging tool for identification and evaluation of vulnerable plaque, despite the limited resolution and careful consideration required with the current ct technique. Cad is increasingly shifting toward identification of vulnerable plaque. Multimodality imaging to detect vulnerable plaque in coronary. Pdf vulnerable plaque, characteristics, detection, and. Atherosclerosis is the most common form of vascular disease and constitutes the major cause of death, with 17. Us200309739a1 method and device to treat vulnerable. Plaques that are vulnerable to rupture demonstrate distinct histological characteristics, including large plaque and necrotic core volumes, extensive remodeling of the vessel at the lesion site.
Historically, the most important diagnostic technique for studying coronary atherosclerotic disease was to determine the residual luminal. The contribution of pathologists has been critical in pointing out the role of the vulnerable plaque in the pathogenesis of acute coronary syndromes, and the major role of thrombus formation. Handbook of the vulnerable plaque defines weak plaque, explains how can it be detected and whore probably candidates for weak plaque. The challenge to detect and to treat vulnerable plaques and. Vulnerable plaque, characteristics, detection, and potential therapies.
The notion of the vulnerable plaque arose from autopsy studies that disclosed twothirds to threefourths of fatal acute myocardial. Evaluation and management of the vulnerable plaque request pdf. Plaque rupture is the main cause of luminal thrombosis in acs 56. A call for new definitions and risk assessment strategies. Ultrasound and biochemical diagnostic tools for the. The notion of vulnerable atherosclerotic plaque introduced many years ago 1,2 has been since used frequently and liberally, including by this investigator. In addition, the levels were related to other vulnerable plaque characteristics and baseline clinical data. The socalled vulnerable plaque may be an additional cause of embolism due to thrombus creation or rupture of the plaque itself. Vascular wall imaging of vulnerable atherosclerotic. Regarding treatment options, it is true that numerous vulnerable plaques usually coexist in patients at risk for cardiovascular events.
In a preferred embodiment, the implanted structure is a stentlike structure sls, and the heating of the implanted structure is a noninvasive inductive heating. Inadequacy of modern approaches to detect plaque vulnerability. This information is plotted as an additional image to the ivus echogram a plaque with a high strain region at the surface with adjacent low strain regions is defined as a vulnerable plaque. The never ending search for the elusive vulnerable plaque. How do we prevent the vulnerable atherosclerotic plaque from. With several new chapters covering mainly diagnostic and treatment options, the handbook of the vulnerable plaque will remain the benchmark text for all interventi. A quote often attributed to albert einstein defines insanity as doing the same thing over and over again and expecting different results.
Article information, pdf download for how do we prevent the vulnerable. Imaging of the carotid artery vulnerable plaque springerlink. Figure 2 shows a typical example of a vulnerable plaque. Recent technological advancements, including dual energy ct and improved gantry times, have led to the ability to image coronary arteries with excellent spatial resolution at low radiation doses.
However, the definition of lowattenuation plaque also differs from study to study, with hounsfield units hu ranging from 3060 5,68,19,21,22,24,27, although. Vascular wall imaging of vulnerable atherosclerotic carotid. Ultrasound and biochemical diagnostic tools for the characterization of vulnerable carotid atherosclerotic plaque. Most, but not all, 2, 3 acute cardiac events occur in the context of plaque. Circulating immunoglobulins are not associated with. The vulnerable plaque 2nd edition pdf free download ebook description since publication of the first edition, advances in the diagnosis and prevention and treatment strategies of the vulnerable plaque have necessitated this greatly expanded second edition.
Pdf vulnerable plaque, characteristics, detection, and potential. Oct 23, 2016 plaques with a specific morphological phenotype that are at high risk of causing acs are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Because of the relatively low spatial resolution of cta, minor inconsistencies may. Arithmetic of vulnerable plaques for noninvasive imaging. The plaque regions between the intima and mediaadventitial borders were. Davies and colleagues described plaque rupture almost 30 years ago. A requiem for vulnerable plaque the vulnerable plaque concept may not represent the contemporary challenge, an unmet clinical need, or a fertile field for future research, wrote peter libby and gerard pasterkamp last summer in the european heart journal.
In addition, other sources of vulnerability from thrombogenic blood and ischemic or arrhythmogenic myocardium must be considered. The purpose of this study was to characterize cardiovascular tissue components and analyze the different tissue properties for predicting coronary vulnerable plaque from intravascular ultrasound ivus images. This report also expands on a technical report on vulnerable plaque that we conducted in 2004. Since publication of the first edition, advances in the diagnosis and prevention and treatment strategies of the vulnerable plaque have necessitated this greatly expanded second edition. Pet tracers for vulnerable plaque imaging springerlink. Overall, approximately 75% of the arteries showed 75% crosssectional luminalnarrowing, indicating that sites with 50% diameter stenosis are the most useful for the detection of vulnerable plaque. Vulnerable plaque and einsteins definition of insanity. A method for treating a vulnerable plaque associated with a blood vessel of a patient is disclosed. Cvia current concepts of vulnerable plaque on coronary ct. Intravascular imaging aims at detecting vulnerable and unstable atherosclerotic plaques in patients undergoing in vasive coronary angiography. These ruptureprone plaques are called vulnerable plaques. The role of shear stress in the destabilization of vulnerable.
In doing so, we assume that given enough time or the. Regarding vulnerable patientlevel and vulnerable plaquelevel endpoints, the independent correlates of ncmace during followup are shown in table 3. Several studies have been carried out on vulnerable plaque as the main culprit for ischaemic cardiac events. July 17, 2006 from vulnerable plaque to vulnerable patient. With its excellent spatial resolution, oct is ideally placed to identify vulnerable plaque that could result in acs. Atherosclerotic disease burden for coronary artery disease. The external carotid artery is seen just above and to the right of the internal carotid artery. For this purpose, sequential ivus image frames were obtained from human coronary arteries using 20 mhz catheters. Abstractcardiovascular disease cvd is the number one cause of death globally, and the majority of.
Keywords atherosclerosis, vulnerable plaque, shear stress. Atheromatous plaques can be identified using ctca and assessed to establish the risk of acute. The role of shear stress in the destabilization of. Pursuit for the detection of vulnerable plaque european. Us20070129718a1 method for treating vulnerable plaque. All the contributors to this amount are revered worldwide for his or her work on this space. Doherty and mcmillen point out the several proatherogenic properties of endothelin1. These lesions have common histological and pathophysiological features, including inflammatory cell infiltration, neoangiogenesis, remodelling, haemorrhage predisposition, thin fibrous cap, large lipid core, and microcalcifications. Vulnerable plaque in a swine model of carotid atherosclerosis.
How to download handbook of the vulnerable plaque pdf. Vulnerable atherosclerotic plaque effective health care. The morphological traits typically associated with ruptureprone plaques 11, 19, 20, 21 are found in lesions usually referred to as thincap fibroatheroma tcfa and are shown in figure 1. Imaging of the carotid artery vulnerable plaque pdf paperity. Evaluation and management of the vulnerable plaque. Identification of patients and plaques vulnerable to.
The purpose of this study was to develop the first animal model of vulnerable carotid atherosclerotic plaque. For this reason, carotid atherosclerotic disease needs to be diagnosed and those determinants that are associated to an increased risk of stroke need to be. Ct coronary angiography ctca is increasingly being used to diagnose coronary artery disease cad. Ppt vulnerable plaque powerpoint presentation free to. As recently reported, plaque erosion is the underlying mechanism responsible for 2560% of acs. A plaque was considered vulnerable in palpography when a highstrain region was present at the lumenplaque boundary that was surrounded by low strain values. Morteza naghavi and erling falk society for heart attack. Optical coherence tomography oct is a highresolution intravascular imaging modality that enables detailed visualization of atheromatous plaques. Atherosclerosis involving the carotid arteries has a high prevalence in the population worldwide. Rupture of thincap fibroatheromas 1 vulnerable plaques suspected to be ruptureprone, is the most common cause of arterial thrombotic events, and occurs most frequently at. Carotid atherosclerotic models were created in 12 yucatan.
Concept of vulnerableunstable plaque arteriosclerosis. Rupture of thincap fibroatheromas 1 vulnerable plaques suspected to be ruptureprone, is the most common cause of arterial thrombotic events, and occurs most frequently at the entrance section. Vulnerable atherosclerotic plaque effective health care program. Transitioning from a focus on individual lesions to. Coronary calcification is associated with high risk for cardiovascular events. Vulnerable plaque, characteristics, detection, and. The concept of vulnerable plaque was born, referring to those plaques parameters that concur to the instability of the plaque making it more prone to the rupture and distal embolization.
Pdf from vulnerable plaque to vulnerable patient a call for new. Intravascular palpography for vulnerable plaque assessment. Terminology for highrisk and vulnerable coronary artery. Plaques with a specific morphological phenotype that are at high risk of causing acs are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Pathology studies have demonstrated the common association of acute myocardial infarction with the rupture or erosion of a coronary atherosclerotic plaque, most frequently a thincap fibroatheroma tcfa, characterized by a large lipid or necrotic core separated from the coronary arterial lumen by a thin membrane cap. Oxldligg, total igg and total ige levels were measured in 5 patients who underwent carotid endarterectomy. Most of the acute ischemic events, such as acute coronary syndromes and stroke, are attributed to vulnerable plaques. Carotid atherosclerotic models were created in 12 yucatan minipigs by using a. The method includes positioning an electrical lead adjacent a vulnerable plaque lesion, and then delivering at least one electrical pulse to the lesion. Note the presence of lowattenuation tissue abutting the lumen, suggestive of a tcfa arrows, b. Report of a meeting on the vulnerable plaque, june 17 and 18, 2003, santorini, greece. Imaging of the carotid artery vulnerable plaque pdf. Vulnerable atherosclerotic plaque comprises a lipidrich necrotic core, covered by a thin fibrous cap, that is weakened by macrophage infiltration. Request pdf pet tracers for vulnerable plaque imaging most of the acute ischemic events, such as acute coronary syndromes and stroke, are attributed to vulnerable plaques.
It remains a challenge to determine at an early stage if atherosclerotic plaque will become unstable and vulnerable. A group of investigators met for two days in santorini, greece, to discuss progress in the field of identification and treatment of high risk vulnerable atherosclerotic plaques and patients. It has been generally considered as the standard model. The lipid core of a vulnerable plaque may correspond to a lowattenuation area on ct. In the present study we defined the intrinsic calcification angle ica as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. Distal embolism and acute thrombosis due to rupture of a vulnerable atherosclerotic plaque are the common mechanisms of stroke in patients with carotid disease. Analysis of cardiovascular tissue components for the. One of the possible processes that play a role in rendering a plaque vulnerable is the presence of an inflammatory process. The defining characteristics of a vulnerable plaque include.
This condition is significant because accidents of the carotid artery plaque are associated with the development of cerebrovascular events. Detection and treatment of vulnerable plaques and vulnerable. A method and device to treat cardiovascular vulnerable plaque is provided by heating an implanted structure placed adjacent to a vulnerable plaque tissue to conduct heat into the vulnerable plaque tissue for a period of time. Granted application number us10044,475 other versions us6786904b2 en. A vulnerable plaque is a kind of atheromatous plaque a collection of white blood cells primarily macrophages and lipids including cholesterol in the wall of an artery that is particularly unstable and prone to produce sudden major problems such as a heart attack or stroke. Pathogenesis of vulnerable atherosclerotic plaques. Circulating immunoglobulins are not associated with intraplaque mast cell number and other vulnerable plaque characteristics in patients with carotid artery stenosis. Oct for the identification of vulnerable plaque in acute. For the maxlcbi 4mm as a continuous variable, the unadjusted hr was 121 95% ci 1095. Plaque containing a thin fibrous cap, lipid pools and macrophages. The hypothesis that plaque behavior could be favorably altered by preventing mastcell degranulation or by inhibiting mastcell proteases is intriguing but as yet unproven.
Jun 01, 2004 report of a meeting on the vulnerable plaque, june 17 and 18, 2003, santorini, greece. Pet tracers for vulnerable plaque imaging request pdf. An underestimated source of intraplaque hemorrhage. A vulnerable plaque is a kind of atheromatous plaque a collection of white blood cells primarily macrophages and lipids including cholesterol in the wall of an artery that is particularly unstable and prone to produce sudden major problems such as a heart attack or stroke the defining characteristics of a vulnerable plaque include but are not limited to. Dangerous forms of atherosclerotic plaques that can rupture or induce thrombosis and lead to critical disruption of blood flow. Terminology for highrisk and vulnerable coronary artery plaques. Imaging of the carotid artery vulnerable plaque, cardiovascular and interventional radiology, 2014, pp. Vulnerable plaque an overview sciencedirect topics. Vulnerable plaque annals of internal medicine american. Vulnerable plaque, a future culprit plaque the term vulnerable is defined by english dictionaries as susceptible to injury or susceptible to attack, 20 as in we are vulnerable both by water and land, without either fleet or army alexander. A group of investigators met for two days in santorini, greece, to discuss progress in the field of identification and treatment of high riskvulnerable atherosclerotic plaques and patients. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.
Intravascular photoacoustic imaging of atherosclerotic plaque. Download handbook of the vulnerable plaque pdf ebook. A signature that has been proven in a prospective study to identify a plaque that is prone to disrupt and can be recognised and measured in the cath lab. Vulnerable plaque may explain outcomes in older carotid. However, its impact on plaque vulnerability is incompletely understood. On the other hand, epidemiological studies reported that. Thats exactly what has happened with efforts to identify the elusive entity of vulnerable plaque using various coronary imaging modalities. History of atherosclerosis and vulnerable plaque research. Treatment for sca, the evaluation of survivors, and the outcomes of sca are discussed separately. They argued, like nissen, that vulnerable plaque lesions are far more. Another important issue that has been overlooked in vulnerable plaque research is the underlying mechanism.