This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Ambrose, J. A. Search for Related Content PubMed Articles by Ambrose, J. A.

VIEWPOINT

In Search of the "Vulnerable Plaque"

Can it Be Localized and Will Focal Regional Therapy Ever Be an Option for Cardiac Prevention?

University of California, San Francisco, Fresno, California.

Manuscript received September 25, 2007; revised manuscript received December 7, 2007, accepted December 17, 2007.

^_* Reprint requests and correspondence: Dr. John A. Ambrose, 2823 Fresno Street, Fresno, California 93721. (Email: jamambrose{at}yahoo.com).

The search to find the location of future plaque ruptures or plaque erosions leading to myocardial infarction (so-called "vulnerable plaques") is an important area of cardiovascular research. Systemic therapy, including use of statins, targets the vulnerable patient. However, adverse events cannot be completely eliminated with the appropriate application of systemic therapies and thus has given rise to the possibility of local or regional therapy of "vulnerable plaques" to prevent future events. Until now, no criteria have been developed for consideration of this therapy. For such a strategy to work, there should be several prerequisites. These involve the identification of susceptible lesions, the number of lesions, their natural history, and proof that an interventional technique is preferable to medical therapy alone. The greatest deficiency relates to the fact that until the natural history of presumed "vulnerable plaques" is known one can never truly identify what constitutes a "vulnerable plaque." Much work needs to be done in this area, but ongoing and new trials should provide important information that could potentially change drastically how coronary artery disease is diagnosed and treated.

Abbreviations and Acronyms   IVUS = intravascular ultrasound   OCT = optical coherence tomography   TCFA = thin-capped fibroatheroma

This article has been cited by other articles:

				R. Chacko, M. Mulhearn, V. Novack, L. Novack, L. Mauri, S. A. Cohen, J. Moses, M. B. Leon, and D. E. Cutlip Impact of Target Lesion and Nontarget Lesion Cardiac Events on 5-Year Clinical Outcomes After Sirolimus-Eluting or Bare-Metal Stenting J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 498 - 503. [Abstract] [Full Text] [PDF]

				A. J. Duerinckx The Nonculprit Coronary Lesion as Seen by Coronary CT Angiography: What Should We Be Looking For? Am. J. Roentgenol., August 1, 2008; 191(2): 439 - 440. [Full Text] [PDF]