Chapter

Virtual histology intravascular ultrasound and optical coherence tomography in percutaneous coronary intervention

Ravinay Bhindi and Keith M. Channon

in Oxford Textbook of Interventional Cardiology

Published on behalf of Oxford University Press

ISBN: 9780199569083
Published online July 2011 | e-ISBN: 9780199697816 | DOI: http://dx.doi.org/10.1093/med/9780199569083.003.011

Series: Oxford Textbooks

Virtual histology intravascular ultrasound and optical coherence tomography in percutaneous coronary intervention

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The inadequacies of angiography to identify and characterize coronary atherosclerosis were not fully appreciated until pathologic studies revealed that coronary atherosclerosis in patients with fatal myocardial infarction was typically diffuse and in many cases was accompanied by positive remodelling, without luminal stenosis. Pathologic studies also identified the critical pathophysiogical role of plaque rupture in coronary thrombosis, and the appreciation that plaque biology and composition, rather than luminal stenosis alone, were more critical determinants of plaque behaviour. Clinical and experimental studies have shown that the vulnerable plaque, prone to rupture, is characterized by a large lipid core rich in inflammatory cells, a thin fibrous cap, and by positive remodelling.

The development of novel intracoronary imaging techniques has enabled a greater appreciation of plaque composition in the pathogenesis of coronary artery disease in living patients. In particular, advances in intravascular ultrasound (IVUS) to provide ‘virtual histology’ of coronary plaque components, and optical coherence tomography (OCT) to define plaque composition in exquisite detail have provided new insights into the relationships between coronary plaque, the risk of clinical events, and the response of the vessel wall to percutaneous intervention.

Chapter.  5094 words.  Illustrated.

Subjects: Radiology ; Cardiovascular Medicine

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