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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:1333.)
© 2003 American Heart Association, Inc.

Brief Reviews

Intravascular Modalities for Detection of Vulnerable Plaque

Current Status

Briain D. MacNeill; Harry C. Lowe; Masamichi Takano; Valentin Fuster; Ik-Kyung Jang

From the Division of Cardiology (B.D.M., H.C.L., M.T., I.-K.J.), Massachusetts General Hospital and Harvard Medical School, Boston, Mass, and the Zena and Michael A. Wiener Cardiovascular Institute (V.F.), Mount Sinai Medical Center, New York, NY.

Correspondence to Ik-Kyung Jang, MD, PhD, Cardiology Division, Bigelow/Gray 800, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. E-mail Jang.ik{at}mgh.harvard.edu

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.

Key Words: atherosclerosis • acute coronary syndrome • coronary imaging

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