Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep 21;78(12):1257-1265.
doi: 10.1016/j.jacc.2021.06.050.

Optical Coherence Tomography of Plaque Vulnerability and Rupture: JACC Focus Seminar Part 1/3

Aaron D Aguirre  1 , Armin Arbab-Zadeh  2 , Tsunenari Soeda  3 , Valentin Fuster  4 , Ik-Kyung Jang  5
Affiliations
Review

Optical Coherence Tomography of Plaque Vulnerability and Rupture: JACC Focus Seminar Part 1/3

Aaron D Aguirre et al. J Am Coll Cardiol. .

Abstract

Plaque rupture is the most common cause of acute coronary syndromes and sudden cardiac death. Characteristics and pathobiology of vulnerable plaques prone to plaque rupture have been studied extensively over 2 decades in humans using optical coherence tomography (OCT), an intravascular imaging technique with micron scale resolution. OCT studies have identified key features of plaque vulnerability and described the in vivo characteristics and spatial distribution of thin cap fibroatheromas as major precursors to plaque rupture. In addition, OCT data supports the evolving understanding of coronary heart disease as a panvascular process associated with inflammation. In the setting of high atherosclerotic burden, plaque ruptures often occur at multiple sites in the coronary arteries, and plaque progression and healing are dynamic processes modulated by systemic risk factors. This review details major investigations with intravascular OCT into the biology and clinical implications of plaque vulnerability and plaque rupture.

Keywords: acute coronary syndrome; optical coherence tomography; plaque rupture; plaque vulnerability; vascular biology.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Dr Aguirre has received research support from the National Institutes of Health (R21EB026762, R01HL144515) and the American Heart Association (14FTF20380185); and has received research grant funding from Amgen Inc and Philips Healthcare Inc. Dr Arbab-Zadeh has received grant support from Canon Medical Systems. Dr Jang has received research support from the Allan Gray Fellowship Fund and from Mr. and Mrs. Michael and Kathryn Park; has received educational grants from Abbott Vascular; and has received a consulting fee from Svelte Medical Systems Inc and Mitobridge Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1:
Figure 1:
Prototype OCT system and a catheter built at MGH in 2002.
Figure 2:
Figure 2:
A. First in vivo comparison of OCT and IVUS (4). An eccentric fibrous plaque is seen at 9 o’clock. B. Post-thrombolysis angiogram and the first OCT demonstration of a ruptured thin fibrous cap (arrows), lipid-rich plaque (L), and residual thrombus (T).
Central Illustration:
Central Illustration:. OCT Imaging of TCFA and Plaque Rupture
OCT identifies features of plaque vulnerability at high resolution including A) TCFA (yellow arrows) B) Macrophage present in the fibrous cap (red arrows), C) thrombus (yellow *), and D) microchannels indicating neovascularization (green arrows). Plaque rupture (E) is visualized on OCT with a disrupted fibrous cap (red arrow) and plaque cavity (red *). F) Plaque rupture culprit lesions in STEMI have high frequency of lipid plaque and TCFA, microchannels, and positive remodeling. Data reproduced from (19). G) Spatial distribution of TCFA indicates clustering of lesions in the proximal aspects of the LAD and LCx and a two peak distribution in the RCA. Figure modified from (23).
See this image and copyright information in PMC

References

    1. Huang D, Swanson EA, Lin CP et al. Optical coherence tomography. Science 1991;254:1178–81. - PMC - PubMed
    1. Brezinski ME, Tearney GJ, Bouma BE et al. Imaging of coronary artery microstructure (in vitro) with optical coherence tomography. Am J Cardiol 1996;77:92–3. - PubMed
    1. Tearney GJ, Jang IK, Kang DH et al. Porcine coronary imaging in vivo by optical coherence tomography. Acta Cardiol 2000;55:233–7. - PubMed
    1. Jang IK, Bouma BE, Kang DH et al. Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. J Am Coll Cardiol 2002;39:604–9. - PubMed
    1. Jang IK, Tearney GJ, MacNeill B et al. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 2005;111:1551–5. - PMC - PubMed

Publication types

MeSH terms