New methods to image unstable atherosclerotic plaques

Abstract

Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity. Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too. In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies.

Specific matrix metalloproteinases and calcification factors are associated with the vulnerability of human carotid plaque

“…Atherosclerosis is the critical risk factor associated with the onset of stroke. Carotid stenosis is a serious long-term outcome of atherosclerosis (31,32). Carotid atherosclerotic plaques, particularly vulnerable carotid plaques were closely associated with ischemic stroke (33).…”

Coronary Atherosclerosis Imaging

“…Non-contrast enhanced CMR can identify some vulnerable plaque characteristics, such as vascular remodeling, inflammation, and intra-plaque hemorrhage due to high T1 weighted signal which is associated with methaemoglobin, a key constituent of acute coronary thrombus [83]. While high-intensity intracoronary signals have been associated with early thrombus formation, high-intensity intra-wall signals have been related to the presence of macrophages and lipid-rich plaques, validated by intravascular imaging [84].…”

CXCR4-binding PET tracers link monocyte recruitment and endothelial injury in murine atherosclerosis

“…In this respect, positron emission tomography (PET) is attractive because of its high sensitivity and its potential for coupling to probes that allow functional evaluation of molecular and cellular aspects. Some specific radioligands are now being used or considered to target the specific pathophysiological process in atherosclerosis (2,(6)(7)(8).…”