One of vascular imagings largest obstacles is identification of the vulnerable plaque. Unfortunately the current gold standard of imaging, digital angiography is largely anatomic in its value. Not physiologic. The ideal modality would allow us to detect the plaque that has characteristics that are identified to be closely associated with plaque rupture. Plaque rupture is the event which typicall leads to vessel occlusion and acute ischemia in the brain or heart. The event usually involves rupture of unstable lipid-laden material which is followed by platelet aggregation and in severe case, thrombus adherence. If one is lucky, the entire lumen of the blood veseel is not completely occluded.
Various modalities like ultrasound have identified characteristics of plaques that are more consistent with embolization like heterogenicity. Cardiac Interventions Today presents a review article discussing current investigational modalities in this important area of plaque characterization
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