Document Detail


Concept of vulnerable/unstable plaque.
MedLine Citation:
PMID:  20554950     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Aloke V Finn; Masataka Nakano; Jagat Narula; Frank D Kolodgie; Renu Virmani
Publication Detail:
Type:  Historical Article; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Arteriosclerosis, thrombosis, and vascular biology     Volume:  30     ISSN:  1524-4636     ISO Abbreviation:  Arterioscler. Thromb. Vasc. Biol.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-17     Completed Date:  2010-07-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9505803     Medline TA:  Arterioscler Thromb Vasc Biol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1282-92     Citation Subset:  IM    
Affiliation:
Emory University School of Medicine, Atlanta, GA, USA.
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MeSH Terms
Descriptor/Qualifier:
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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