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Imaging Vulnerable Plaque by Ultrasound

Anthony N. DeMaria, MD, MACC^_*,a,_*, Jagat Narula, MD, PhD, FACC, Ehtisham Mahmud, MD, FACC^_* and Sotirios Tsimikas, MD, FACC^_*

^_* Division of Cardiology, University of California San Diego, San Diego, California, USA
Division of Cardiology, University of California-Irvine School of Medicine, Irvine, California, USA

Manuscript received June 16, 2005; revised manuscript received November 2, 2005, accepted November 8, 2005.

^_* Reprint requests and correspondence: Dr. Anthony N. DeMaria, Cardiology Division, UCSD Medical Center, 200 West Arbor Drive, San Diego, California 92103-8411 (Email: ademaria{at}ucsd.edu).

Diagnostic techniques to identify vulnerable plaques are rapidly evolving. Intravascular ultrasound (IVUS) has the ability to detect and localize plaque as well as quantitate plaque burden. Recent IVUS studies have suggested that patients presenting with acute coronary syndromes have an approximate 25% incidence of additional ruptured plaques in arteries other than the culprit lesion. The ability of IVUS to detect vulnerable plaques before rupture is currently being evaluated by novel techniques. Initially, IVUS was shown to be able to characterize plaque broadly as calcified or fibrofatty but was limited in its ability to more precisely detect lipid-rich plaques, necrotic cores, and thrombus. Recent advances in new applications of IVUS, such as integrated backscatter, wavelet analysis, and virtual histology, have focused on evaluating and mathematically transforming the radiofrequency signal from ultrasound waves into a color-coded representation of plaque characteristics such as lipid, fibrous tissue, calcification, and necrotic core. In addition, targeted contrast agents, applicable to both intravascular and transthoracic studies, are being evaluated in experimental models and aim to highlight specific plaque components, such as endothelial adhesion molecules and other plaque components that might be useful in targeting vulnerable plaques. These advances pave the way for future clinical trials in assessing the ability of such techniques to diagnose vulnerable plaques and to assess the effects of both pharmacologic and mechanical therapies on plaque characteristics.

Abbreviations and Acronyms   3D-IB-IVUS = three-dimensional intravascular ultrasound with integrated back scatter   ACS = acute coronary syndromes   ICAM = intracellular adhesion molecules   IVUS = intravascular ultrasound   PS = phosphatidylserine   RF = radiofrequency

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