Visualization of fibrous cap
thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging.
The fibrous cap
can be substantially weakened by matrix degrading enzymes known as matrix metalloproteinases (MMPs) (99,100).
Vulnerable plaques are inflamed, lipid-rich lesions that form in the walls of the arteries and usually have thin, fibrous caps
For example, a patient catheterized following acute coronary syndrome who is found to have lipid-laden plaques with thin fibrous caps
might be more likely to get more aggressive medical management after stenting of the main lesion.
Intravascular ultrasound (IVUS) is frequently used to provide direct imaging of the vessel wall, but with resolution in excess of 100 microns, even the best IVUS images are unable to show early stages of disease such as intimal thickening, or to identify thin fibrous caps
, a hallmark of plaques believed to be the cause of up to 70% of all sudden cardiac deaths.
Most heart attacks occur after fibrous caps
covering these fatty deposits rupture.
Lipid measurement and cardiac imaging cannot identify which patients have rupture-prone plaque with thin fibrous caps
Jang presented preliminary data from the MGH-Guidant study, which demonstrated that OCT is able to successfully detect morphological characteristics of coronary lesions that have been associated with heart attacks, including lipid pools and their thin fibrous caps
that are susceptible to rupture.