Jacc Focus Seminar: Optical Coherence Tomography Studies in Coronary Atherosclerosis
JACC Focus Seminar
Optical Coherence Tomography of Plaque Vulnerability and Rupture: JACC Focus Seminar Part 1/3

https://doi.org/10.1016/j.jacc.2021.06.050Get rights and content
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Highlights

  • OCT studies have confirmed plaque rupture as the most common cause of ACS.

  • OCT features of plaque vulnerability are more prevalent in lesions with greater plaque burden and more severe stenosis.

  • ACS involve diverse vascular pathology with local manifestations.

Abstract

Plaque rupture is the most common cause of acute coronary syndromes and sudden cardiac death. Characteristics and pathobiology of vulnerable plaques prone to plaque rupture have been studied extensively over 2 decades in humans using optical coherence tomography (OCT), an intravascular imaging technique with micron scale resolution. OCT studies have identified key features of plaque vulnerability and described the in vivo characteristics and spatial distribution of thin cap fibroatheromas as major precursors to plaque rupture. In addition, OCT data supports the evolving understanding of coronary heart disease as a panvascular process associated with inflammation. In the setting of high atherosclerotic burden, plaque ruptures often occur at multiple sites in the coronary arteries, and plaque progression and healing are dynamic processes modulated by systemic risk factors. This review details major investigations with intravascular OCT into the biology and clinical implications of plaque vulnerability and plaque rupture.

Key Words

acute coronary syndrome
optical coherence tomography
plaque rupture
plaque vulnerability
vascular biology

Abbreviations and Acronyms

ACS
acute coronary syndromes
LAD
left anterior descending artery
LCx
left circumflex artery
NSTEMI/UA
non–ST-segment elevation myocardial infarction/unstable angina
OCT
optical coherence tomography
RCA
right coronary artery
STEMI
ST-segment elevation myocardial infarction
TCFA
thin cap fibroatheroma

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Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

David X. Zhao, MD, served as Guest Associate Editor for this paper. Javed Butler, MD, MPH, MBA, served as Guest Editor-in-Chief for this paper.

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