MacNeill Briain D, Lowe Harry C, Takano Masamichi, Fuster Valentin, Jang Ik-Kyung
Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
Arterioscler Thromb Vasc Biol. 2003 Aug 1;23(8):1333-42. doi: 10.1161/01.ATV.0000080948.08888.BF. Epub 2003 Jun 12.
Progress in the diagnosis, treatment, and prevention of atherosclerotic coronary artery disease is dependent on a greater understanding of the mechanisms of coronary plaque progression. Autopsy studies have characterized a subgroup of high-risk, or vulnerable, plaques that result in acute coronary syndromes or sudden cardiac death. These angiographically modest plaques share certain pathologic characteristics: a thin, fibrous cap, lipid-rich core, and macrophage activity. Diagnostic techniques for vulnerable-plaque detection, including serologic markers and noninvasive and invasive techniques, are needed. Recent advances in intravascular imaging have significantly improved the ability to detect high-risk, or vulnerable, plaque in vivo by using various features of plaque vulnerability as methods of identification. The characteristic anatomy of a thin, fibrous cap overlying a lipid pool has promoted high-resolution imaging, such as intravascular ultrasound, optical coherence tomography, and intracoronary magnetic resonance. The lipid-rich core is identifiable by angioscopically detected color changes on the plaque surface or by its unique absorption of energy, or "Raman shift," of its cholesterol core, driving coronary spectroscopy. Finally, temperature heterogeneity arising at foci of plaque inflammation has prompted the development of intracoronary thermography. In this review, we will discuss these techniques, their relative advantages and limitations, and their potential clinical application.
动脉粥样硬化性冠状动脉疾病在诊断、治疗和预防方面的进展取决于对冠状动脉斑块进展机制的更深入了解。尸检研究已明确了导致急性冠状动脉综合征或心源性猝死的高危或易损斑块亚组。这些在血管造影上表现不明显的斑块具有某些病理特征：薄纤维帽、富含脂质的核心和巨噬细胞活性。需要用于检测易损斑块的诊断技术，包括血清学标志物以及非侵入性和侵入性技术。血管内成像的最新进展通过利用斑块易损性的各种特征作为识别方法，显著提高了在体内检测高危或易损斑块的能力。覆盖脂质池的薄纤维帽的特征性解剖结构推动了高分辨率成像技术的发展，如血管内超声、光学相干断层扫描和冠状动脉内磁共振成像。富含脂质的核心可通过血管镜检测到的斑块表面颜色变化或其胆固醇核心独特的能量吸收（即“拉曼位移”）来识别，这推动了冠状动脉光谱学的发展。最后，斑块炎症灶处出现的温度异质性促使了冠状动脉内热成像技术的发展。在本综述中，我们将讨论这些技术、它们的相对优势和局限性以及它们潜在的临床应用。
