Abstract
The identification of the coronary “vulnerable plaque” that is prone to disruption
and thrombosis remains a “holy grail” in the treatment of coronary artery disease.
The widespread use of coronary angiography for the identification of coronary atherosclerotic
disease has led to numerous earlier studies exploring the role of angiography in the
early detection of the vulnerable plaque. Some of the angiographic features explored
for risk of plaque rupture include the degree of luminal stenosis, presence of plaque
calcification, complex lesions with plaque disruption and thrombosis, and coronary
artery movement patterns. However, a major limiting factor with coronary angiography
is that it is a “luminogram”, and provides little characterization of plaque morphology
or vessel wall, both of which play an important role in the development of plaque
vulnerability. Newer intravascular imaging techniques have been developed to permit
more detailed interrogation of plaque morphology and vessel wall, potentially allowing
for more accurate detection of plaque vulnerability. Whilst coronary angiography may
be increasingly superseded by these advances in imaging technologies, it is likely
that it will continue to play an important complementary role in the quest for the
early detection of the vulnerable plaque. The prospective identification of the vulnerable
plaque currently remains elusive, as definitive tools for its detection do not exist.
Hence, further prospective studies on the natural history of the atherosclerotic plaque,
as well as validation of imaging modalities in clinical studies are needed before
the notion of early detection of the vulnerable plaque becomes a clinical reality.
Keywords
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Article info
Publication history
Published online: January 31, 2012
Accepted:
January 10,
2012
Received in revised form:
October 29,
2011
Received:
July 29,
2011
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
