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Angiography for Detection of Complex and Vulnerable Atherosclerotic Plaque

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Asymptomatic Atherosclerosis

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Selective coronary angiography is the “gold standard” for detection of atherosclerosis and quantitation of the magnitude of obstructive disease. Unfortunately, angiography has intrinsic limitations in that it provides a two-dimensional “lumenogram” that at best delineates the effects of plaque in the vessel wall that encroaches on the lumen. While these images delineate the gross presence of disease and can quantify percent stenosis, angiography consistently underestimates the magnitude of atherosclerotic burden. Angiography is very accurate in the detection of complex unstable plaques in patients with acute coronary syndromes. Unfortunately, it has substantial limitations in delineating whether a noncomplex lesion is stable, vulnerable, or in transition to complex-unstable pathology. Furthermore, angiography is also limited in that this data can only be obtained as a “snapshot” in time in the tiny fraction of athersosclerotic patients who end up in the catheterization laboratory. This chapter elucidates the clinical data regarding the following: (1) strengths and limits of angiography for quantification of coronary plaque, (2) angiographic patterns of complex unstable plaque, (3) evidence of pancoronary inflammation and its relationship to multifocal plaque instability, (4) natural history of angiographically complex lesions, and (5) limitations of angiography in detection of unstable and vulnerable plaques.

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Authors and Affiliations

  1. Division of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA

    James A. Goldstein

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  1. James A. Goldstein
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Editors and Affiliations

  1. Endothelix, Inc., El Rio 8275, Houston, 77054, USA

    Morteza Naghavi

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Goldstein, J.A. (2011). Angiography for Detection of Complex and Vulnerable Atherosclerotic Plaque. In: Naghavi, M. (eds) Asymptomatic Atherosclerosis. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-179-0_33

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  • DOI: https://doi.org/10.1007/978-1-60327-179-0_33

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-178-3

  • Online ISBN: 978-1-60327-179-0

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