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Gerard Pasterkamp - One of the best experts on this subject based on the ideXlab platform.
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requiem for the Vulnerable Plaque
European Heart Journal, 2015Co-Authors: Peter Libby, Gerard PasterkampAbstract:The concept of the so-called ‘Vulnerable Plaque’ has proved highly useful to guide research and thinking regarding the pathophysiology of the acute coronary syndromes (ACS). Yet, the time may have come to reconsider this construct, as knowledge has accumulated, the risk profile of the populace has shifted, and our current therapies have reshaped the disease. Over the last several decades, the quest to identify and treat the ‘Vulnerable Plaque’ has generated much interest.1 Loaded with lipid, macrophage rich, covered by a thin fibrous cap, and considered perilously poised to rupture, the thin-capped fibroatheroma (TCFA) has become a target for imaging, possible intervention, model attempts in animals, and much discussion.2 Many equate type 1 myocardial infarction with ‘Plaque rupture’. Yet, the ‘Vulnerable Plaque’ concept, as useful as it has proved heuristically, may not represent the contemporary challenge, an unmet clinical need, or a fertile field for future research. The notion of the ‘Vulnerable Plaque’ arose from autopsy studies that disclosed some two-thirds to three-fourths of fatal acute myocardial infarctions resulted from a fracture of the Plaque's fibrous cap that engendered thrombosis ( Table 1 ; Figure 1 ). The elegant post-mortem studies of pathologist pioneers redirected the cardiology community from confusion about the causality of thrombosis in ACS and a focus on vasospasm towards Plaque rupture.3,4 However compelling, the number of ruptured Plaques resulting in luminal occlusion in these autopsy studies lacked a ‘denominator’. While such studies could interrogate the culprit of a fatal myocardial infarction, they did not determine how many Plaques with morphologic characteristics associated with vulnerability did not cause a fatal rupture. View this table: Table 1 Challenges to the ‘Vulnerable Plaque’ concept Figure 1 Contrasts between …
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detecting the Vulnerable Plaque in patients
Journal of Internal Medicine, 2015Co-Authors: Isabel Goncalves, Den H Ruijter, Matthias Nahrendorf, Gerard PasterkampAbstract:Atherosclerosis is a systemic condition that eventually evolves into Vulnerable Plaques and cardiovascular events. Pathology studies reveal that rupture-prone atherosclerotic Plaques have a distinct morphology, namely a thin, inflamed fibrous cap covering a large lipidic and necrotic core. With the fast development of imaging techniques in the last decades, detecting Vulnerable Plaques thereby identifying individuals at high risk for cardiovascular events has become of major interest. Yet, in current clinical practice, there is no routine use of any vascular imaging modality to assess Plaque characteristics as each unique technique has its pros and cons. This review describes the techniques that may evolve into screening tool for the detection of the Vulnerable Plaque. Finally, it seems that Plaque morphology has been changing in the last decades leading to a higher prevalence of 'stable' atherosclerotic Plaques, possibly due to the implementation of primary prevention strategies or other approaches. Therefore, the nomenclature of Vulnerable Plaque lesions should be very carefully defined in all studies.
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Atherosclerotic Plaque Biomarkers: Beyond the Horizon of the Vulnerable Plaque
Current Cardiology Reviews, 2011Co-Authors: Guus W. Van Lammeren, Frans L. Moll, Gert J. De Borst, Dominique P.v. De Kleijn, Jean-paul P.m. De Vries, Gerard PasterkampAbstract:Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local Plaque vulnerability, leading to thrombus formation and cardiovascular events. Due to the burden of cardiovascular disease, identification of patients at risk for cardiovascular events and treatment stratification is needed. The predictive power of classical risk factors is limited, especially in patients with manifest atherosclerosis. Imaging modalities have focused on the characteristics of the Vulnerable Plaque. However, it has become evident that not all so-called Vulnerable Plaques lead to rupture and subsequent thrombosis. The latter obviously limits the positive predictive value for imaging assessment of Plaques and patients at risk. Serum biomarkers have also been studied extensively, but have very limited application in a clinical setting for risk stratification. In line with the important relation between Vulnerable Plaques and cardiovascular events, Plaque biomarker studies have been initiated. These longitudinal studies are based on the concept, that a Vulnerable Plaque contains predictive information for future cardiovascular events, also in other territories of the vascular tree. Results look promising and Plaque markers can be used to develop imaging modalities to identify patients at risk, or to monitor treatment effect. Plaque biomarker studies do not challenge the definition of the Vulnerable Plaque, but use its concept in favor of prediction improvement for vascular patients.
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heme oxygenase 1 determines atherosclerotic lesion progression into a Vulnerable Plaque
Circulation, 2009Co-Authors: Caroline Cheng, Patrick W Serruys, Gerard Pasterkamp, Henricus J. Duckers, Frans L. Moll, Annemarie M Noordeloos, Viktoria Jeney, Miguel P SoaresAbstract:Background— The molecular regulation for the transition from stable to Vulnerable Plaque remains to be elucidated. Heme oxygenase 1 (HO-1) and its metabolites have been implicated in the cytoprotective defense against oxidative injury in atherogenesis. In this study, we sought to assess the role of HO-1 in the progression toward Plaque instability in carotid artery disease in patients and in a murine model of Vulnerable Plaque development. Methods and Results— Atherectomy biopsy from 112 patients with clinical carotid artery disease was collected and stratified according to characteristics of Plaque vulnerability. HO-1 expression correlated closely with features of Vulnerable human atheromatous Plaque (P<0.005), including macrophage and lipid accumulation, and was inversely correlated with intraPlaque vascular smooth muscle cells and collagen deposition. HO-1 expression levels correlated with the Plaque destabilizing factors matrix metalloproteinase-9, interleukin-8, and interleukin-6. Likewise, in a vuln...
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from Vulnerable Plaque to Vulnerable patient the search for biomarkers of Plaque destabilization
Trends in Cardiovascular Medicine, 2007Co-Authors: Willem E Hellings, Frans L. Moll, Wouter Peeters, Gerard PasterkampAbstract:There is a strong need for biomarkers to identify patients at risk for future cardiovascular events related with progressive atherosclerotic disease. Ideally, increasing knowledge of the mechanisms of atherosclerotic Plaque destabilization should be translated in clinical practice. Currently, the following commonly followed strategies can be identified with the objective to detect either the local Vulnerable Plaque that is prone to rupture and gives rise to a thrombotic occlusion, or the systemic Vulnerable patient, who has a high probability to suffer from an adverse clinical event. On the one hand, studies are ongoing to determine local atherosclerotic Plaque characteristics to predict future local Plaque rupture and subsequent vascular thrombosis. Newly developed imaging modalities are being developed and validated to detect these Plaques in vivo. On the other hand, systemic approaches are pursued to discover serum biomarkers that are applicable to define patients at risk for future cardiovascular events. We propose a third original approach that is optional but yet unexplored, that is, to use local Plaque characteristics as a biomarker not just for local Plaque destabilization but for future cardiovascular events due to Plaque progression in any vascular system. This review aims to provide an overview of the current standings of the identification of the Vulnerable Plaque and the Vulnerable patient.
Patrick W Serruys - One of the best experts on this subject based on the ideXlab platform.
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Intravascular palpography for high-risk Vulnerable Plaque assessment.
Herz, 2020Co-Authors: Johannes A Schaar, Evelyn Regar, Cornelis J. Slager, Pim J. De Feyter, Frits Mastik, Chris L. De Korte, Anton F. W. Van Der Steen, R A Baldewsing, Patrick W SerruysAbstract:The composition of an atherosclerotic Plaque is considered more important than the degree of stenosis. An unstable lesion may rupture and cause an acute thrombotic reaction. Most of these lesions contain a large lipid pool covered by an inflamed thin fibrous cap. The stress in the cap increases with decreasing cap thickness and increasing macrophage infiltration. Intravascular ultrasound (IVUS) palpography might be an ideal technique to assess the mechanical properties of high-risk Plaques. Palpography assesses the local mechanical properties of tissue using its deformation caused by the intraluminal pressure. The technique was validated in vitro using diseased human coronary and femoral arteries. Especially between fibrous and fatty tissue, a highly significant difference in strain (p = 0.0012) was found. Additionally, the predictive value to identify the Vulnerable Plaque was investigated. A high-strain region at the lumen-vessel wall boundary has an 88% sensitivity and 89% specificity for identifying such Plaques. In vivo, the technique was validated in an atherosclerotic Yucatan minipig animal model. This study also revealed higher strain values in fatty than fibrous Plaques (p < 0.001). The presence of a high-strain region at the lumenPlaque interface has a high predictive value to identify macrophages. Patient studies revealed high-strain values (1–2%) in thin-cap fibrous atheroma. Calcified material showed low strain values (0–0.2%). With the development of three-dimensional (3-D) palpography, identification of highstrain spots over the full length of a coronary artery becomes available. Intravascular palpography is a unique tool to assess lesion composition and vulnerability. The development of 3-D palpography provides a technique that may develop into a clinical tool to identify the high-risk Plaque.
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heme oxygenase 1 determines atherosclerotic lesion progression into a Vulnerable Plaque
Circulation, 2009Co-Authors: Caroline Cheng, Patrick W Serruys, Gerard Pasterkamp, Henricus J. Duckers, Frans L. Moll, Annemarie M Noordeloos, Viktoria Jeney, Miguel P SoaresAbstract:Background— The molecular regulation for the transition from stable to Vulnerable Plaque remains to be elucidated. Heme oxygenase 1 (HO-1) and its metabolites have been implicated in the cytoprotective defense against oxidative injury in atherogenesis. In this study, we sought to assess the role of HO-1 in the progression toward Plaque instability in carotid artery disease in patients and in a murine model of Vulnerable Plaque development. Methods and Results— Atherectomy biopsy from 112 patients with clinical carotid artery disease was collected and stratified according to characteristics of Plaque vulnerability. HO-1 expression correlated closely with features of Vulnerable human atheromatous Plaque (P<0.005), including macrophage and lipid accumulation, and was inversely correlated with intraPlaque vascular smooth muscle cells and collagen deposition. HO-1 expression levels correlated with the Plaque destabilizing factors matrix metalloproteinase-9, interleukin-8, and interleukin-6. Likewise, in a vuln...
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first case of stenting of a Vulnerable Plaque in the secritt i trial the dawn of a new era
Nature Reviews Cardiology, 2009Co-Authors: Steve Ramcharitar, Evelyn Regar, Nieves Gonzalo, Robert Jan Van Geuns, Hector M Garciagarcia, Joanna J Wykrzykowska, Jurgen Ligthart, Patrick W SerruysAbstract:BACKGROUND: A 63-year-old man presented with class II anginal symptoms. INVESTIGATIONS: Cardiac catheterization, intravascular ultrasound (IVUS) virtual histology, optical coherence tomography and off-line palpography. DIAGNOSIS: The patient was diagnosed as having a culprit lesion in the left circumflex artery and a Vulnerable Plaque in the left anterior descending artery. MANAGEMENT: The culprit lesion was treated with two overlapping drug-eluting stents. The Vulnerable Plaque was then treated with a self-expanding stent tailored to shield Vulnerable Plaques (vProtect Luminal Shield). After dilatation of the stent with a low-pressure balloon, IVUS and optical coherence tomography showed excellent apposition of the stent to the vessel wall, with no signs of tissue prolapse or edge dissections. At the 6-month follow-up appointment, the stent showed complete tissue coverage without signs of in-stent restenosis. CONCLUSIONS: Six months of follow-up has demonstrated that a patient with an IVUS-derived, thin capped fibroatheroma was successfully treated with a stent tailored to shield Vulnerable Plaques.
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handbook of the Vulnerable Plaque
2007Co-Authors: Ron Waksman, Patrick W Serruys, Johannes A SchaarAbstract: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. With several new chapters covering mainly diagnostic and treatment options, The Handbook of the Vulnerable Plaque will remain the benchmark text for all interventional cardiologists treating Vulnerable patients by providing the physician with comprehensive insight into the world of the Vulnerable Plaque.
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current diagnostic modalities for Vulnerable Plaque detection
Current Pharmaceutical Design, 2007Co-Authors: Johannes A Schaar, Patrick W Serruys, Evelyn Regar, Frits Mastik, Frank J H Gijsen, Jolanda J Wentzel, A F W Van Der StehenAbstract:Rupture of Vulnerable Plaques is the main cause of acute coronary syndrome and myocardial infarction. Identification of Vulnerable Plaques is therefore essential to enable the development of treatment modalities to stabilize such Plaques. Several diagnostic methods are currently tested to detect Vulnerable Plaques. Angiography has a low discriminatory power to identify the Vulnerable Plaque, but does provide information about the entire coronary tree and serves as guide for invasive imaging techniques and therapy. Angioscopy offers a direct visualization of the Plaque surface and intra- luminal structures like thrombi and tears. However, angioscopy is difficult to perform, invasive and only the proximal part of the vessels can be investigated. IVUS (intravascular ultrasound) provides some insight into the composition of Plaques. The detection of Vulnerable Plaques is mainly based on series of case reports with a lack of prospectivity and follow- up. Palpography, an IVUS derived technique, reveals information, which is not recognizable in IVUS. It can differentiate between deformable and non-deformable tissue, which enables the technique to detect Vulnerable Plaques with a positive predictive value. The clinical value of palpography is currently under investigation. Thermography assesses the temperature heterogeneity as an indicator of the metabolic state of the Plaque. A coincidence of temperature rise and localization of Vulnerable Plaque was suggested. OCT (optical coherence tomography) can provide images with ultrahigh resolution utililizing the back-reflection of near-infrared light from optical interfaces in tissue. Drawbacks are the low penetration depth into tissue and the absorbance of light by blood. Raman spectroscopy can provide quantification about the molecular composition of the Plaque. Long acquisition time, the low penetration depth and light absorbance by blood limit the performance of the technique. Another light emitting technique is NIR (near infrared spectroscopy), which identifies lipid loaded Plaques and is tested currently in clinical trials. Non-invasive MRI (magnetic resonance imaging) and multislice spiral computed tomography (MSCT), with their excellent ability to identify lipid-rich tissue, have been utilized to characterize potentially Vulnerable Plaques foremost in non-moving structures like the carotid arteries. Due to the resolution of the techniques small Plaque structure cannot be assessed. The role of non-invasive imaging in Vulnerable Plaque detection is currently under investigation. Several invasive and non-invasive techniques are currently under development to assess the Vulnerable Plaque. Most of the techniques show exiting features, but none have proven their value in an extensive in vivo validation and all have a lack of prospective data.
Valentin Fuster - One of the best experts on this subject based on the ideXlab platform.
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from detecting the Vulnerable Plaque to managing the Vulnerable patient jacc state of the art review
Journal of the American College of Cardiology, 2019Co-Authors: Armin Arbabzadeh, Valentin FusterAbstract:Abstract The past decades have seen tremendous progress on elucidating mechanisms leading to acute coronary syndrome and sudden cardiac death. Pathology and imaging studies have identified features of coronary atherosclerosis that precede acute coronary events. However, many factors influence the risk of adverse events from coronary atherosclerotic disease and available data support our transition from focusing on individual “Vulnerable Plaque,” coronary arterial stenosis, and inducible myocardial ischemia to understanding coronary heart disease as multifactorial, chronic disease. The concept of the Vulnerable patient has evolved, with the atheroma burden, its metabolic activity, and the disposition to vascular thrombosis building a platform for assessing central aspects of coronary heart disease. In turn, this model has directed us to a focus on controlling the activity of atherosclerotic disease and on modifying the susceptibility of vascular thrombosis which has led to reduced morbidity and mortality from coronary heart disease.
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intravascular modalities for detection of Vulnerable Plaque current status
Arteriosclerosis Thrombosis and Vascular Biology, 2003Co-Authors: Briain D Macneill, Harry C Lowe, Masamichi Takano, Valentin Fuster, Ikkyung JangAbstract:Progress in the diagnosis, treatment, and prevention of atherosclerotic coronary artery disease is dependent on a greater understanding of the mechanisms of coronary Plaque progression. Autopsy studies have characterized a subgroup of high-risk, or Vulnerable, Plaques that result in acute coronary syndromes or sudden cardiac death. These angiographically modest Plaques share certain pathologic characteristics: a thin, fibrous cap, lipid-rich core, and macrophage activity. Diagnostic techniques for Vulnerable-Plaque detection, including serologic markers and noninvasive and invasive techniques, are needed. Recent advances in intravascular imaging have significantly improved the ability to detect high-risk, or Vulnerable, Plaque in vivo by using various features of Plaque vulnerability as methods of identification. The characteristic anatomy of a thin, fibrous cap overlying a lipid pool has promoted high-resolution imaging, such as intravascular ultrasound, optical coherence tomography, and intracoronary magnetic resonance. The lipid-rich core is identifiable by angioscopically detected color changes on the Plaque surface or by its unique absorption of energy, or “Raman shift,” of its cholesterol core, driving coronary spectroscopy. Finally, temperature heterogeneity arising at foci of Plaque inflammation has prompted the development of intracoronary thermography. In this review, we will discuss these techniques, their relative advantages and limitations, and their potential clinical application.
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is there a Vulnerable Plaque
Circulation, 2003Co-Authors: Attilio Maseri, Valentin FusterAbstract:The identification of potential triggers of acute coronary syndromes (ACS) represented by unstable angina (UA), myocardial infarction (MI) (preceded or not by UA), and sudden coronary death (SCD) is a rapidly growing area of research. Coronary Plaque disruption and subsequent thrombosis is the major recognized pathogenetic component of “unstable Plaques,” which characterize the transition from stable coronary artery disease (CAD) to ACS. However, in the presence of unstable or even stable Plaques, a thrombogenic state or “high-risk blood” may contribute, at least in some cases, to the development of ACS.1 Furthermore, thrombosis is also an integral component of the chronic atherothrombotic progression of atherosclerosis. Although the observation that Plaque disruption leads to ACS goes back a number of decades, the notion of “Vulnerable Plaques” was first developed a little over a decade ago on the basis of post-mortem observations in patients with ACS.2 At the site of culprit coronary lesions, a rupture was often found at the shoulder of atheromatous Plaques with a large pultaceous lipid core and a thin fibrous cap. Such rupture was originally thought to be the result of localized mechanical shear stress forces.3 However, on the basis of emerging evidence of a prevalent inflammatory component in ACS, inflammatory mechanisms of Plaque instability began to receive considerable attention.4 The acquisition of knowledge does not necessarily makes things more comprehensible, but rather often adds novel complexities. Yet, when confronted with a pressing issue, such as predicting major future adverse events, there is a natural inclination to accept generalizations not yet justified by available data. The intriguing concept of a Vulnerable Plaque, as a potential short-term precursor of unstable Plaques, derives from the theoretical possibility of identifying those coronary atherosclerotic Plaques that might become unstable and thus trigger ACS. The notion of Vulnerable Plaques is …
Johannes A Schaar - One of the best experts on this subject based on the ideXlab platform.
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Visualization of the Vulnerable Plaque
Cardiovascular Research, 2020Co-Authors: Rob Krams, Johannes A Schaar, Frank Helderman, Caroline Cheng, Babak Mousavi Gourabi, L.c.a. Van Damme, Dolf Segers, Evelyn Regar, Cornelis J. Slager, Pim J. De FeyterAbstract:Thrombosis is the main cause of acute coronary syndrome and myocardial infarction (Naghavi et al., 2003). The mechanism underlying thrombus formation is presently under debate, but several pathological conditions have been identified fromhuman postmortem studies that correspondwith the presence of thrombus. Of these conditions Plaque rupture is the most common, but erosion of the endothelial layer and existence of calcified nodules without the existence of Plaque rupture have also been identified. Plaques that have been ruptured have certain features in common (Falk, 1999; Virmani et al., 2002): (i) size of the lipid core (40% of the entire Plaque), (ii) thickness of the fibrous cap (less than 65 μm), (iii) presence of inflammatory cells, (iv) amount of remodeling and extent of Plaque-free vessel wall. Several terms have been identified focusing either on the pathological aspects (“thin-cap fibroatheroma”) or on the possibility to rupture (“rupture-prone Plaques”) or on the possibility to induce thrombosis (“Vulnerable Plaque”). As Vulnerable Plaque is the term encompassing all other terms, therefore this term will be used throughout the chapter.
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Intravascular palpography for high-risk Vulnerable Plaque assessment.
Herz, 2020Co-Authors: Johannes A Schaar, Evelyn Regar, Cornelis J. Slager, Pim J. De Feyter, Frits Mastik, Chris L. De Korte, Anton F. W. Van Der Steen, R A Baldewsing, Patrick W SerruysAbstract:The composition of an atherosclerotic Plaque is considered more important than the degree of stenosis. An unstable lesion may rupture and cause an acute thrombotic reaction. Most of these lesions contain a large lipid pool covered by an inflamed thin fibrous cap. The stress in the cap increases with decreasing cap thickness and increasing macrophage infiltration. Intravascular ultrasound (IVUS) palpography might be an ideal technique to assess the mechanical properties of high-risk Plaques. Palpography assesses the local mechanical properties of tissue using its deformation caused by the intraluminal pressure. The technique was validated in vitro using diseased human coronary and femoral arteries. Especially between fibrous and fatty tissue, a highly significant difference in strain (p = 0.0012) was found. Additionally, the predictive value to identify the Vulnerable Plaque was investigated. A high-strain region at the lumen-vessel wall boundary has an 88% sensitivity and 89% specificity for identifying such Plaques. In vivo, the technique was validated in an atherosclerotic Yucatan minipig animal model. This study also revealed higher strain values in fatty than fibrous Plaques (p < 0.001). The presence of a high-strain region at the lumenPlaque interface has a high predictive value to identify macrophages. Patient studies revealed high-strain values (1–2%) in thin-cap fibrous atheroma. Calcified material showed low strain values (0–0.2%). With the development of three-dimensional (3-D) palpography, identification of highstrain spots over the full length of a coronary artery becomes available. Intravascular palpography is a unique tool to assess lesion composition and vulnerability. The development of 3-D palpography provides a technique that may develop into a clinical tool to identify the high-risk Plaque.
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handbook of the Vulnerable Plaque
2007Co-Authors: Ron Waksman, Patrick W Serruys, Johannes A SchaarAbstract: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. With several new chapters covering mainly diagnostic and treatment options, The Handbook of the Vulnerable Plaque will remain the benchmark text for all interventional cardiologists treating Vulnerable patients by providing the physician with comprehensive insight into the world of the Vulnerable Plaque.
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current diagnostic modalities for Vulnerable Plaque detection
Current Pharmaceutical Design, 2007Co-Authors: Johannes A Schaar, Patrick W Serruys, Evelyn Regar, Frits Mastik, Frank J H Gijsen, Jolanda J Wentzel, A F W Van Der StehenAbstract:Rupture of Vulnerable Plaques is the main cause of acute coronary syndrome and myocardial infarction. Identification of Vulnerable Plaques is therefore essential to enable the development of treatment modalities to stabilize such Plaques. Several diagnostic methods are currently tested to detect Vulnerable Plaques. Angiography has a low discriminatory power to identify the Vulnerable Plaque, but does provide information about the entire coronary tree and serves as guide for invasive imaging techniques and therapy. Angioscopy offers a direct visualization of the Plaque surface and intra- luminal structures like thrombi and tears. However, angioscopy is difficult to perform, invasive and only the proximal part of the vessels can be investigated. IVUS (intravascular ultrasound) provides some insight into the composition of Plaques. The detection of Vulnerable Plaques is mainly based on series of case reports with a lack of prospectivity and follow- up. Palpography, an IVUS derived technique, reveals information, which is not recognizable in IVUS. It can differentiate between deformable and non-deformable tissue, which enables the technique to detect Vulnerable Plaques with a positive predictive value. The clinical value of palpography is currently under investigation. Thermography assesses the temperature heterogeneity as an indicator of the metabolic state of the Plaque. A coincidence of temperature rise and localization of Vulnerable Plaque was suggested. OCT (optical coherence tomography) can provide images with ultrahigh resolution utililizing the back-reflection of near-infrared light from optical interfaces in tissue. Drawbacks are the low penetration depth into tissue and the absorbance of light by blood. Raman spectroscopy can provide quantification about the molecular composition of the Plaque. Long acquisition time, the low penetration depth and light absorbance by blood limit the performance of the technique. Another light emitting technique is NIR (near infrared spectroscopy), which identifies lipid loaded Plaques and is tested currently in clinical trials. Non-invasive MRI (magnetic resonance imaging) and multislice spiral computed tomography (MSCT), with their excellent ability to identify lipid-rich tissue, have been utilized to characterize potentially Vulnerable Plaques foremost in non-moving structures like the carotid arteries. Due to the resolution of the techniques small Plaque structure cannot be assessed. The role of non-invasive imaging in Vulnerable Plaque detection is currently under investigation. Several invasive and non-invasive techniques are currently under development to assess the Vulnerable Plaque. Most of the techniques show exiting features, but none have proven their value in an extensive in vivo validation and all have a lack of prospective data.
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Comprar The Vulnerable Plaque | Johannes Schaar | 9781841846217 | Informa Healthcare
2007Co-Authors: Johannes A Schaar, Patrick W Serruys, Ron WaksmanAbstract:Tienda online donde Comprar The Vulnerable Plaque al precio 266,83 € de Johannes Schaar | Patrick W. Serruys | Ron Waksman, tienda de Libros de Medicina, Libros de Cardiologia - Cirugia cardiaca
Ikkyung Jang - One of the best experts on this subject based on the ideXlab platform.
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detection of Vulnerable Plaque
2020Co-Authors: Rocco Vergallo, Ikkyung JangAbstract:The use of optical coherence tomography (OCT) imaging in research and clinical practice has provided useful insights into the pathobiology of the “Vulnerable Plaque” and acute coronary syndromes (ACS). Although thin-cap fibroatheroma (TCFA), defined as a lipid-rich Plaque covered by a thin (i.e., <65 μm) fibrous cap, has historically be considered the prototype of the “Vulnerable Plaque”, this term should be reserved for Plaques that are precursors of all three causes of luminal thrombosis, which include not only Plaque rupture but also Plaque erosion and calcified Plaque. In addition, cardiovascular risk profile and demographics of patients with ACS are actively changing worldwide, partly due to the widespread use of statins and other preventive measures, so that Plaque rupture is declining as a cause of ACS, whereas Plaque erosion seems to be on the rise. Therefore, a redefinition of the concept of “Vulnerable Plaque” is probably needed in order to better identify patients at risk for future adverse events and to adopt tailored effective preventive strategies. Current data suggest that rather than focusing on individual coronary Plaques, a more comprehensive, integrative approach focusing on the “Vulnerable patients” may be more appropriate.
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Detection of Vulnerable Plaque
Cardiovascular OCT Imaging, 2019Co-Authors: Rocco Vergallo, Ikkyung JangAbstract:The use of optical coherence tomography (OCT) imaging in research and clinical practice has provided useful insights into the pathobiology of the “Vulnerable Plaque” and acute coronary syndromes (ACS). Although thin-cap fibroatheroma (TCFA), defined as a lipid-rich Plaque covered by a thin (i.e.,
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advances in intravascular imaging new insights into the Vulnerable Plaque from imaging studies
Korean Circulation Journal, 2018Co-Authors: Taishi Yonetsu, Ikkyung JangAbstract:: The term "Vulnerable Plaque" denotes the Plaque characteristics that are susceptible to coronary thrombosis. Previous post-mortem studies proposed 3 major mechanisms of coronary thrombosis: Plaque rupture, Plaque erosion, and calcified nodules. Of those, characteristics of rupture-prone Plaque have been extensively studied. Pathology studies have identified the features of rupture-prone Plaque including thin fibrous cap, large necrotic core, expansive vessel remodeling, inflammation, and neovascularization. Intravascular imaging modalities have emerged as adjunctive tools of angiography to identify Vulnerable Plaques. Multiple devices have been introduced to catheterization laboratories to date, including intravascular ultrasound (IVUS), virtual-histology IVUS, optical coherence tomography (OCT), coronary angioscopy, and near-infrared spectroscopy. With the use of these modalities, our understanding of Vulnerable Plaque has rapidly grown over the past several decades. One of the goals of intravascular imaging is to better predict and prevent future coronary events, for which prospective observational data is still lacking. OCT delineates microstructures of Plaques, whereas IVUS visualizes macroscopic vascular structures. Specifically, Plaque erosion, which has been underestimated in clinical practice, is gaining an interest due to the potential of OCT to make an in vivo diagnosis. Another potential future avenue for intravascular imaging is its use to guide treatment. Feasibility of tailored therapy for acute coronary syndromes (ACS) guided by OCT is under investigation. If it is proven to be effective, it may potentially lead to major shift in the management of millions of patients with ACS every year.
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intravascular detection of the Vulnerable Plaque
Circulation-cardiovascular Imaging, 2011Co-Authors: Arnold H Seto, Ronan Margey, Ignacio Cruzgonzalez, Ikkyung JangAbstract:Coronary heart disease (CHD) remains the leading cause of death in the United States, and an estimated 1.4 million Americans have a heart attack each year. Over the past 2 decades, the concept of the “Vulnerable Plaque” (VP) being responsible for the majority of acute coronary syndromes (ACS) has become widely accepted. Coincidentally, there has been rapid expansion of coronary imaging modalities, both invasive and noninvasive, seeking the ability to detect high-risk Plaques before their disruption and formation of occlusive thrombus. Histological characteristics of the Plaques that are Vulnerable to rupture are thin fibrous cap (<65 μm), large lipid pool, and activated macrophages near the fibrous cap, all of which can be detected with high-resolution coronary imaging.1 Cellular mechanisms associated with Plaque instability include inflammation, reduced collagen synthesis, local overexpression of collagenase, and smooth muscle cell apoptosis. These pathological processes can alter the Plaque surface and its mechanical properties, which also have been targets of recent research. Noninvasive tests, such as CT and MRI are limited by low resolution and are unable to visualize most of the features of VP. At present, only intravascular modalities can potentially distinguish VP from benign types of Plaques. In this review, we focus on the recent data from the various types of intravascular modalities currently available or in development and compare their advantages and limitations. Coronary Plaque develops eccentrically, and increasing Plaque volume induces positive remodeling of the vessel, resulting in external elastic membrane expansion and preservation of luminal area. Coronary angiography only visualizes the coronary lumen and does not provide any information about the characteristics of the arterial wall and its contents. For this reason, coronary angiography has failed as a diagnostic modality for detection of VP, which often causes only modest luminal narrowing. Various histological Plaque components have been targeted as …
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optical coherence tomography for imaging the Vulnerable Plaque
Journal of Biomedical Optics, 2006Co-Authors: J Guillermo M D Tearney, Ikkyung Jang, Brett E BoumaAbstract:While our understanding of Vulnerable coronary Plaque is still at an early stage, the concept that certain types of Plaques predispose patients to developing an acute myocardial infarction continues to be at the forefront of cardiology research. Intracoronary optical coherence tomography (OCT) has been developed to both identify and study these lesions due to its distinct resolution advantage over other imaging modalities. We review clinical research conducted at the Massachusetts General Hospital over the past five years to develop, validate, and utilize this technology to improve our understanding of Vulnerable Plaque. Our results show that intracoronary OCT may be safely conducted in patients and that it provides abundant information regarding Plaque microscopic morphology, which is essential to the identification and study of high-risk lesions. Even though many basic biological, clinical, and technological challenges must be addressed prior to widespread use of this technology, the unique capabilities of OCT ensure that it will have a prominent role in shaping the future of cardiology.
