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REVIEW ARTICLES

Techniques characterizing the coronary atherosclerotic plaque: influence on clinical decision making?

^a Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
^b Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
^c Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Dr. Gerard Pasterkamp is a fellow of the Catharijne Foundation, Utrecht

Manuscript received July 29, 1999; revised manuscript received December 30, 1999, accepted March 1, 2000.

Reprint requests and correspondence: Dr. Gerard Pasterkamp, Experimental Cardiology Laboratory, University Medical Center Utrecht, Heidelberglaan 100, Room G02-523, 3584 CX Utrecht, the Netherlands
g.pasterkamp{at}hli.azu.nl

The composition of the atherosclerotic lesion rather than the degree of stenosis is currently considered to be the most important determinant for acute clinical events. Modalities capable of characterizing the atherosclerotic lesion may be helpful in understanding its natural history and detecting lesions with high risk for acute events. Speaking grossly, three histologic features of the vulnerable plaque have been reported: size of the atheroma, thickness of the fibrous cap, and inflammation. Imaging techniques are currently being deployed and are under development to aid visualization of the vulnerable coronary plaque. Most of these diagnostic modalities have the potential to detect locally one or more of the three histologically defined features of vulnerable plaque. This review will focus on imaging techniques that have been developed to characterize the atherosclerotic lesion. Most catheter-based visualization techniques will provide insight into components of the local atherosclerotic plaque which may limit their predictive value for the occurrence of a clinical event. Therefore, the clinical relevance of these imaging tools will be discussed.

Abbreviations and Acronyms   IVUS = intravascular ultrasound   MMP = matrix metalloproteinase   MRI = magnetic resonance imaging   OCT = optical coherence tomography

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