| Concept of vulnerable/unstable plaque. | |
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MedLine Citation:
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PMID: 20554950 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Today's concept of vulnerable plaque has evolved primarily from the early pioneering work uncovering the pivotal role of plaque rupture and coronary thrombosis as the major cause of acute myocardial infarction and sudden cardiac death. Since the first historical description of plaque rupture in 1844, several key studies by leading researchers and clinicians have lead to the current accepted views on lesion instability. Important to the complex paradigm of plaque destabilization and thrombosis are many discoveries beginning with the earliest descriptions of advanced plaques, reminiscent of abscesses encapsulated by fibrous tissue capable of rupture. It was not until the late 1980s that studies of remodeling provided keen insight into the growth of advanced plaques, beyond the simple accumulation of lipid. The emphasis in the next decade, however, was on a focused shift toward the mechanisms of lesion vulnerability based on the contribution of tissue proteolysis by matrix metalloproteinases as an essential factor responsible for thinning and rupture of the fibrous cap. In an attempt to unify the understanding of what constitutes a vulnerable plaque, morphological studies, mostly from autopsy, suggest the importance of necrotic core size, inflammation, and fibrous cap thickness. Definitive proof of the vulnerable plaque, however, remains elusive because animal or human data supporting a cause-and-effect relationship are lacking. Although emerging imagining technologies involving optical coherence tomography, high-resolution MRI, molecular biomarkers, and other techniques have far surpassed the limits of the early days of angiography, advancing the field will require establishing relevant translational animal models that produce vulnerable plaques at risk for rupture and further testing of these modalities in large prospective clinical trials. |
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Authors:
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Aloke V Finn; Masataka Nakano; Jagat Narula; Frank D Kolodgie; Renu Virmani |
Publication Detail:
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Type: Historical Article; Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Arteriosclerosis, thrombosis, and vascular biology Volume: 30 ISSN: 1524-4636 ISO Abbreviation: Arterioscler. Thromb. Vasc. Biol. Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-06-17 Completed Date: 2010-07-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9505803 Medline TA: Arterioscler Thromb Vasc Biol Country: United States |
Other Details:
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Languages: eng Pagination: 1282-92 Citation Subset: IM |
Affiliation:
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Emory University School of Medicine, Atlanta, GA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Coronary Artery Disease / complications, history*, pathology Diagnostic Imaging / methods Disease Progression Evidence-Based Medicine History, 19th Century History, 20th Century History, 21st Century Humans Myocardial Infarction / etiology, history*, pathology Predictive Value of Tests Risk Assessment Risk Factors Rupture Thrombosis / etiology, history*, pathology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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