Kurihara Osamu, Takano Masamichi, Miyauchi Yasushi, Mizuno Kyoichi, Shimizu Wataru
Cardiovascular Center, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
Mitsukoshi Health and Welfare Foundation, Tokyo, Japan.
J Geriatr Cardiol. 2021 Jul 28;18(7):577-584. doi: 10.11909/j.issn.1671-5411.2021.07.005.
Pathological studies have suggested that features of vulnerable atherosclerotic plaques likely to progress and lead to acute cardiovascular events have specific characteristics. Given the progress of intravascular coronary imaging technology, some large prospective studies have detected features of vulnerable atherosclerotic plaques using these imaging modalities. However, the rate of cardiovascular events, such as acute coronary syndrome, has been found to be considerably reduced in the limited follow-up period available in the statin era. Additionally, not all disrupted plaques lead to thrombus formation with clinical presentation. If sub-occlusive or occlusive thrombus formation does not occur, a thrombus on a disrupted plaque will organize without any symptoms, forming a "healed plaque". Although vulnerable plaque detection using intracoronary imaging is focused on "thin-cap fibroatheroma" leading to plaque rupture, superficial plaque erosion is increasingly recognized; however, the underlying mechanism of thrombus formation on eroded plaques is not well understood. One of intravascular imaging, optical coherence tomography (OCT) has the highest image resolution and has enabled detailed characterization of the plaque . Here, we reviewed the status and limitations of intravascular imaging in terms of detecting vulnerable plaque through mainly OCT studies. We suggested that vulnerable plaque should be reconsidered in terms of eroded plaque and healed plaque and that both plaque and circulating blood should be assessed in greater detail accordingly.
病理学研究表明，易进展并导致急性心血管事件的易损动脉粥样硬化斑块具有特定特征。鉴于血管内冠状动脉成像技术的进展，一些大型前瞻性研究已使用这些成像方式检测到易损动脉粥样硬化斑块的特征。然而，在他汀类药物时代有限的随访期内，已发现急性冠状动脉综合征等心血管事件的发生率显著降低。此外，并非所有破裂斑块都会导致有临床表现的血栓形成。如果未发生亚闭塞性或闭塞性血栓形成，破裂斑块上的血栓将在没有任何症状的情况下机化，形成“愈合斑块”。尽管使用冠状动脉内成像检测易损斑块主要关注导致斑块破裂的“薄帽纤维粥样斑块”，但浅表斑块侵蚀越来越受到认可；然而，侵蚀斑块上血栓形成的潜在机制尚不清楚。血管内成像之一，光学相干断层扫描（OCT）具有最高的图像分辨率，并能够对斑块进行详细表征。在此，我们主要通过OCT研究综述了血管内成像在检测易损斑块方面的现状和局限性。我们建议应从侵蚀斑块和愈合斑块的角度重新考虑易损斑块，并相应地更详细地评估斑块和循环血液。
