Invasive or non-invasive imaging for detecting high-risk coronary lesions?

Abstract

Introduction: Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an arsenal of invasive and non-invasive imaging modalities have been developed that are capable of identifying these features allowing in vivo assessment of plaque vulnerability. Areas covered: This review article presents the available and emerging imaging modalities introduced to assess plaque morphology and biology, describes the evidence from the first large scale studies that evaluated the efficacy of invasive and non-invasive imaging in detecting lesions that are likely to progress and cause cardiovascular events and discusses the potential implications of the in vivo assessment of coronary artery pathology in the clinical setting. Expert commentary: Invasive imaging, with its high resolution, and in particular hybrid intravascular imaging appears as the ideal approach to study the mechanisms regulating atherosclerotic disease progression; whereas non-invasive imaging is expected to enable complete assessment of coronary tree pathology, detection of high-risk lesions, more accurate risk stratification and thus to allow a personalized treatment of vulnerable patients. ARTICLE HISTORY

Vulnerable Plaque, Characteristics, Detection, and Potential Therapies

“…Imaging techniques focus on general morphological parameters and are only indirectly connected to the actual cause of plaque severity [26,89]. The IVUS method allows for the direct imaging of vessel wall screening in ruptured plaques and is poor at noncoronary lipid assessment [90].…”

Ultrasound/Optical Dual‐Modality Imaging for Evaluation of Vulnerable Atherosclerotic Plaques with Osteopontin Targeted Nanoparticles

“…At present, clinical imaging such as coronary angiography, intravascular ultrasonography, and optical coherence tomography are expensive and invasive, which could also produce some certain complications like thrombosis formation, infection, and coronary artery dissection . The other imaging methods including coronary computed tomography angiography and magnetic resonance imaging (MRI) usually put much more emphasis on the internal structure of the vessel or the extend of luminal stenosis anatomically, so that the composition within the lesion which play a vital role in the progression of atherosclerosis plaques is ignored .…”

Magnetic Resonance Imaging of Atherosclerotic Plaque at Clinically Relevant Field Strengths (1T) by Targeting the Integrin α4β1

“…No relevant, clinically available noninvasive techniques have been developed to analyze the total inflammatory cell burden in atherosclerotic plaques. Because outcomes-based clinical scores are not accurate in predicting patients who are at high risk of acute ischemic events 57 , there is a need to develop noninvasive techniques that could be widely available and accurately stratify patient risk and possibly guide clinical trials. Here, we have shown that potent small molecule antagonists of the integrin α4β1, a key receptor on inflammatory leukocytes that mediates cell recruitment to atherosclerotic plaques 9 – 11 , can be modified for use in targeting liposomal-gadolinium contrast agents to α4β1-expressing inflammatory cells.…”