Identifying and Treating Vulnerable Atherosclerotic Plaques

Acute coronary syndromes and, in particular, ST-elevation myocardial infarction are usually caused by coronary thrombosis in which the thrombus develops either on a disrupted plaque (usually a thin-capped fibroatheroma) or an eroded atherosclerotic plaque. These thrombus-prone plaques are vulnerable...

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Bibliographic Details
Published inThe American journal of cardiology Vol. 205; pp. 214 - 222
Main Authors Ambrose, John A., Sharma, Avinash V.
Format Journal Article
LanguageEnglish
Published New York Elsevier Inc 15.10.2023
Elsevier Limited
Subjects
Acute coronary syndromes
Angiography
Arteriosclerosis
Atherosclerosis
Blood clots
Cardiovascular disease
Catheters
Computed tomography
Confidence intervals
Coronary vessels
FDA approval
Histology
Lesions
Lipids
Medical imaging
Myocardial infarction
plaque erosion
Plaques
Risk
thin-capped fibroatheroma
Thromboembolism
Thrombosis
Tomography
vulnerable plaque
atherosclerosis
plaque erosion
thin-capped fibroatheroma
vulnerable plaque
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Summary:Acute coronary syndromes and, in particular, ST-elevation myocardial infarction are usually caused by coronary thrombosis in which the thrombus develops either on a disrupted plaque (usually a thin-capped fibroatheroma) or an eroded atherosclerotic plaque. These thrombus-prone plaques are vulnerable or high-risk. Although, traditionally, cardiologists have concentrated on treating significant coronary obstruction, there has been great interest over the last 2 decades in possibly preventing the thrombotic causes of myocardial infarction/sudden coronary death by mostly identifying and stabilizing these asymptomatic vulnerable or high-risk plaques, which, at least on invasive angiography, are mostly nonobstructive. Computed tomographic angiography and intravascular imaging during invasive coronary angiography have now been shown to identify a majority of these vulnerable or high-risk plaques before symptoms, thus opening up new preventive strategies. In conclusion, this article discusses the identification and management of these thrombus-prone lesions and patients with these lesions either with noninvasive techniques and systemic therapies or possibly through a new and bold interventional paradigm.
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ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2023.07.121