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Coronary Atherosclerotic Plaque
Stephan Achenbach, MD, FESC, FACC, FSCCT
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Deposit that develops in intimal layer of coronary arteries and consists of lipids, fibrous tissue, smooth muscle cells, and calcium
              • Necrotic core can be present, covered by fibrous cap
              • Atherosclerotic plaque can develop into coronary artery stenosis
              • Most plaques are not associated with relevant luminal stenosis
              • Acute coronary syndromes (myocardial infarction and unstable angina) occur as result of plaque rupture with subsequent thrombosis of vessel lumen
                • Immediately before rupture, plaques are often not associated with relevant luminal stenosis

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  • Angiographic Findings

                    • Other Modality Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Williams MC et al: Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART Study. J Am Coll Cardiol. 73(3):291-301, 2019
                                  2. Ferencik M et al: Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol. 3(2):144-152, 2018
                                  3. Dweck MR et al: MR imaging of coronary arteries and plaques. JACC Cardiovasc Imaging. 9(3):306-16, 2016
                                  4. Gerretsen S et al: Detection of coronary plaques using MR coronary vessel wall imaging: validation of findings with intravascular ultrasound. Eur Radiol. 23(1):115-24, 2013
                                  5. Hadamitzky M et al: Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. Eur Heart J. 34(42):3277-85, 2013
                                  6. Narula J et al: Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 61(10):1041-51, 2013
                                  7. Voros S et al: Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging. 4(5):537-48, 2011
                                  8. Achenbach S et al: Imaging of coronary atherosclerosis by computed tomography. Eur Heart J. 31(12):1442-8, 2010
                                  9. Guédès A et al: Intravascular ultrasound assessment of atherosclerosis. Curr Atheroscler Rep. 6(3):219-24, 2004
                                  10. Goldstein JA: Angiographic plaque complexity: the tip of the unstable plaque iceberg. J Am Coll Cardiol. 39(9):1464-7, 2002
                                  11. Gutstein DE et al: Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res. 41(2):323-33, 1999
                                  12. Falk E: Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol. 63(10):114E-120E, 1989
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Deposit that develops in intimal layer of coronary arteries and consists of lipids, fibrous tissue, smooth muscle cells, and calcium
                                              • Necrotic core can be present, covered by fibrous cap
                                              • Atherosclerotic plaque can develop into coronary artery stenosis
                                              • Most plaques are not associated with relevant luminal stenosis
                                              • Acute coronary syndromes (myocardial infarction and unstable angina) occur as result of plaque rupture with subsequent thrombosis of vessel lumen
                                                • Immediately before rupture, plaques are often not associated with relevant luminal stenosis

                                          IMAGING

                                          • General Features

                                            • CT Findings

                                              • MR Findings

                                                • Echocardiographic Findings

                                                  • Angiographic Findings

                                                    • Other Modality Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Williams MC et al: Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART Study. J Am Coll Cardiol. 73(3):291-301, 2019
                                                                  2. Ferencik M et al: Use of High-Risk Coronary Atherosclerotic Plaque Detection for Risk Stratification of Patients With Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol. 3(2):144-152, 2018
                                                                  3. Dweck MR et al: MR imaging of coronary arteries and plaques. JACC Cardiovasc Imaging. 9(3):306-16, 2016
                                                                  4. Gerretsen S et al: Detection of coronary plaques using MR coronary vessel wall imaging: validation of findings with intravascular ultrasound. Eur Radiol. 23(1):115-24, 2013
                                                                  5. Hadamitzky M et al: Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. Eur Heart J. 34(42):3277-85, 2013
                                                                  6. Narula J et al: Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 61(10):1041-51, 2013
                                                                  7. Voros S et al: Coronary atherosclerosis imaging by coronary CT angiography: current status, correlation with intravascular interrogation and meta-analysis. JACC Cardiovasc Imaging. 4(5):537-48, 2011
                                                                  8. Achenbach S et al: Imaging of coronary atherosclerosis by computed tomography. Eur Heart J. 31(12):1442-8, 2010
                                                                  9. Guédès A et al: Intravascular ultrasound assessment of atherosclerosis. Curr Atheroscler Rep. 6(3):219-24, 2004
                                                                  10. Goldstein JA: Angiographic plaque complexity: the tip of the unstable plaque iceberg. J Am Coll Cardiol. 39(9):1464-7, 2002
                                                                  11. Gutstein DE et al: Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res. 41(2):323-33, 1999
                                                                  12. Falk E: Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol. 63(10):114E-120E, 1989