RESEARCH ARTICLE


The Vulnerable Plaque: the Real Villain in Acute Coronary Syndromes



Michael Liang 1, Aniket Puri 1, 2, Gerard Devlin 1, *
1 Department of Cardiology, Waikato Hospital, New Zealand
2 Department of Cardiology, CSM Medical University (Former King George Medical University), Lucknow, India


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© Lianget al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Clinical Unit Leader, Cardiology, Cardiothoracic Surgery and Vascular Surgery Unit. Waikato Hospital, Pembroke & Selwyn Sts, Hamilton 3240, New Zealand; Tel: 0064-7-839-8899; Fax: 0064-7-839-8799; Email: gerard.devlin@waikatodhb.health.nz


Abstract

The term "vulnerable plaque" refers to a vascular lesion that is prone to rupture and may result in life-threatening events which include myocardial infarction. It consists of thin-cap fibroatheroma and a large lipid core which is highly thrombogenic. Acute coronary syndromes often result from rupture of vulnerable plaques which frequently are only moderately stenosed and not visible by conventional angiography. Several invasive and non-invasive strategies have been developed to assess the burden of vulnerable plaques. Intravascular ultrasound provides a two-dimensional cross-sectional image of the arterial wall and can help assess the plaque burden and composition. Optical coherent tomography offers superior resolution over intravascular ultrasound. High-resolution magnetic resonance imaging provides non-invasive imaging for visualizing fibrous cap thickness and rupture in plaques. In addition, it may be of value in assessing the effects of treatments, such as lipid-lowering therapy. Technical issues however limit its clinical applicability. The role of multi-slice computed tomography, a well established screening tool for coronary artery disease, remains to be determined. Fractional flow reserve (FFR) may provide physiological functional assessment of plaque vulnerability; however, its role in the management of vulnerable plaque requires further studies. Treatment of the vulnerable patient may involve systemic therapy which currently include statins, ACE inhibitors, beta-blockers, aspirin, and calcium-channel blockers and in the future local therapeutic options such as drug-eluting stents or photodynamic therapy.

Keywords: Vulnerable plaque, coronary artery disease..