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Detection of Vulnerable Plaque

  • Rocco Vergallo
  • Ik-Kyung JangEmail author
Chapter

Abstract

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.

Keywords

Vulnerable plaque Thin-cap fibroatheroma Optical coherence tomography Pan-vascular vulnerability Risk stratification 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiovascular and Thoracic SciencesFondazione Policlinico A. Gemelli IRCCS – Università Cattolica Sacro CuoreRomeItaly
  2. 2.Division of Cardiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

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