Atherosclerosis and Atheroma Plaque Rupture: Imaging Modalities in the Visualization of Vasa Vasorum and Atherosclerotic Plaques

Abstract

Invasive angiography has been widely accepted as the gold standard to diagnose cardiovascular pathologies. Despite its superior resolution of demonstrating atherosclerotic plaque in terms of degree of lumen stenosis, the morphological assessment for the plaque is insufficient for the analysis of plaque components, and therefore, unable to predict the risk status or vulnerability of atherosclerotic plaque. There is an increased body of evidence to show that the vasa vasorum play an important role in the initiation, progression, and complications of atherosclerotic plaque leading to major adverse cardiac events. This paper provides an overview of the evidence-based reviews of various imaging modalities with regard to their potential value for comprehensive characterization of the composition, burden, and neovascularization of atherosclerotic plaque.

Vasa Vasorum in Atherosclerosis and Clinical Significance

“…In balloon-injured arteries, in which the oxygen supply in the arterial wall is impaired, newly formed VV may compensate the shortage of oxygen supply [ 46 , 47 ]. Spatial VV contents were increased from the dense microvessel network in the adventitia and extended to plaques in the presence of atherosclerosis [ 48 , 49 ]. There was an inverse correlation between low VV contents and decreased oxygenation ( i.e.…”

Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

“…Of these three characteristics of vulnerable plaques, the current evidence shows that the napkin-ring sign represents the most reliable indicator of predicting ACS. The possible mechanisms of the napkin-ring sign include intraplaque vasa vasorum enhancement by the CCTA [ 86 , 87 ], intraplaque hemorrhage or thrombus with peripheral enhancement by contrast media, or microcalcifications in the plaque which are strongly associated with the development of future ACS [ 36 ]. Detection of a napkin-ring sign could help identify patients at high risk of future ACS events, although large-scale multicenter studies are needed to confirm these findings.…”

Ginsenoside Rb1 Enhances Plaque Stability and Inhibits Adventitial Vasa Vasorum via the Modulation of miR-33 and PEDF

“…Under physiological conditions, the adventitial vasa vasorum takes up molecules that are transmitted from the blood to the adventitia by mass transport through the arterial wall (24). Lots of studies both in humans and in animal models demonstrate that increased vasa vasorum in the adventitia is associated with plaque instability and rupture, which can cause life-threatening cardiovascular events (22,23,25). Increased permeability of VV fuels atherosclerotic plaque progression.…”