Diagnosis of Vulnerable Plaques in the Cardiac Catheterization Laboratory

This chapter discusses the new developments of imaging techniques that have the potential to detect vulnerable plaques. Rupture of vulnerable plaques is the main cause of acute coronary syndrome and myocardial infarction. Identification of vulnerable plaque is, therefore, essential to enable the development of treatment modalities to stabilize such plaque. Imaging of coronary arteries with magnetic resonance imaging is more difficult than imaging carotid plaques since cardiac and respiratory motion, small plaque size, and the locations of the coronary arteries can cause acquisition problems. Plaques declared vulnerable in elastography had thinner caps than non-vulnerable plaques. It is feasible to apply intravascular palpography during interventional catheterization procedures. Since palpography is based on clinically available intravenous coronary ultrasound catheters, the technique can be easily introduced into the catheterization laboratory. Intracoronary angioscopy offers direct visualization of plaque surfaces and intraluminal structures like tears and thrombi. Optical coherence tomography can provide images with ultrahigh resolution.