Plaque Vulnerability and Plaque Rupture: In Vivo Biology with OCT

• Published in: Journal of the American College of Cardiology 2021-09, Vol.78 (12), p.1257-1265
• Main Authors: Aguirre, Aaron D., Arbab-Zadeh, Armin, Soeda, Tsunenari, Fuster, Valentin, Jang, Ik-Kyung
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2021.06.050

Plaque rupture is the most common cause of acute coronary syndromes and sudden cardiac death. Characteristics and pathobiology of vulnerable plaques prone to plaque rupture have been studied extensively over two decades in humans using optical coherence tomography (OCT), an intravascular imaging technique with micron scale resolution. OCT studies have identified key features of plaque vulnerability and described the in vivo characteristics and spatial distribution of thin cap fibroatheromas as major precursors to plaque rupture. In addition, OCT data supports the evolving understanding of coronary heart disease as a panvascular process associated with inflammation. In the setting of high atherosclerotic burden, plaque ruptures often occur at multiple sites in the coronary arteries and plaque progression and healing are dynamic processes modulated by systemic risk factors. This review details major investigations with intravascular OCT into the biology and clinical implications of plaque vulnerability and plaque rupture. Characteristics and pathobiology of vulnerable plaques prone to plaque rupture have been studied extensively over two decades in humans using intravascular optical coherence tomography (OCT). OCT provided an opportunity to study the in vivo characteristics and spatial distribution of thin cap fibroatheromas as major precursors to plaque rupture. In addition, OCT data supports the evolving understanding of coronary heart disease as a dynamic, panvascular process associated with inflammation. This review details major investigations with intravascular OCT into the biology and clinical implications of plaque vulnerability and plaque rupture.