Intraplaque neovascularization and hemorrhage: markers for cardiovascular risk stratification and therapeutic monitoring.

Atherosclerotic disease results in major clinical events and remains a leading cause of morbidity and mortality in the western World. Atherosclerotic plaques have a heterogeneous presentation. Atherosclerotic plaques with a vulnerable phenotype have been associated with an increased risk for cardiovascular complications. Intraplaque neovascularization and hemorrhage are histopathological features that have been linked with the vulnerable plaque. The role of intraplaque neovascularization and hemorrhage in plaque destabilization and lesion progression has gained serious interest. Intraplaque neovascularization and hemorrhage have been correlated with the occurrence of prior cardiovascular events and have predictive value for the occurrence of future cardiovascular events. Pharmacological interventions showed an inhibiting effect of lipid-lowering drugs on plaque neovascularization. Imaging modalities such as contrast-enhanced ultrasound or MRI are able to visualize intraplaque neovascularization and hemorrhage noninvasively. Consequently, detection of intraplaque neovascularization and hemorrhage visualized with noninvasive imaging might improve the stratification of 'high-risk' patients.