High-Risk Atherosclerotic Plaques: Mechanisms, Imaging, Models, and Therapy

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ISBN: 9780849330285 | 0849330289
Cover: Hardcover
Copyright: 12/20/2004

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Vulnerable plaque development is the result of a complex series of molecular and cellular events involving inflammation, apoptosis, rupture, and thrombosis. A detailed understanding of the mechanisms underlying the development of high-risk plaques, along with the ability to visualize and diagnose these vulnerable lesions, will lead to the effective management of acute coronary syndromes.High-Risk Atherosclerotic Plaques: Mechanisms, Imaging, Models, and Therapy brings together timely, in-depth reviews by renowned international cardiologists and scientists. Chapters cover the definition, structure, and cellular and molecular mechanisms of high risk plaque development, as well as animal models of vulnerable plaque, plaque imaging, and current and future therapies. Medical experts discuss intravascular ultrasound, optimal coherence tomography, magnetic resonance imaging, and coronary thermography. The final chapter reviews both current and future local and systematic strategies for the therapeutic management of vulnerable plaque.Exploring all aspects of this primary cause of acute coronary syndromes, this informative book updates our knowledge on the detection and treatment of vulnerable plaques. It is a valuable resource that can greatly advance the progress in treatment and prevention.

Preface

Cellular and Molecular Mechanisms of Plaque Rupture

(18)

Prediman K. Shah

Introduction

(1)

Rupture of Atherosclerotic Plaque Followed by Thrombosis

(7)

Plaque Rupture: Relationship to Plaque Size and Stenosis Severity

(1)

Plaque Rupture: Relationship to Plaque Composition

(1)

Lipid Core

(1)

Plaque Inflammation

(1)

Pathophysiologic Link between Plaque Inflammation and Plaque Rupture

(2)

Role of Plaque Inflammation in Thrombosis Following Plaque Rupture

(1)

Insights from Experimental Models of Plaque Rupture

(1)

Plaque Rupture: Potential Role of Extrinsic Triggers

(1)

Thrombosis without Plaque Rupture: Plaque Erosion and Calcified Nodules

(1)

Determinants of Plaque Vulnerability and Rupture: Implications for Plaque Stabilization through Change in Plaque Phenotype

(1)

Concluding Remarks

(10)

Acknowledgments

(1)

References

(10)

Apoptosis and Plaque Vulnerability

(16)

Martin R. Bennett

Introduction

(1)

Evidence for Apoptosis in the Vasculature

(2)

Remodelling

(1)

Arterial Injury

(1)

Aneurysm Formation

(1)

Atherosclerosis

(1)

Effect of VSMC Apoptosis

(1)

Mechanism of Apoptosis in the Vasculature

(1)

Apoptosis of VSMCs

(2)

Apoptosis of Macrophages

(1)

Apoptosis of Endothelial Cells

(1)

Suicide or Murder?

(1)

Conclusions

(7)

Acknowledgments

(1)

References

(6)

Animal Models of Vulnerable Plaque

(18)

Harry C. Lowe

Levon M. Khachigian

Leonard Kritharides

Jason L. Johnson

Introduction

(1)

Definitions of Vulnerable Plaque and Plaque Rupture

(1)

Histopathology and Pathogenesis of Vulnerable Plaque and Plaque Rupture

(2)

Clinical Sequelae of Vulnerable Plaque and Plaque Rupture

(1)

Systemic and Local Strategies for Vulnerable Plaque Stabilization

(1)

Imaging Vulnerable Plaque

(1)

Assessment of Vulnerability Endpoints Using Traditional Animal Models of Atherosclerosis

(1)

Novel Large Animal Models of Vulnerable Plaque

(1)

Models of Vulnerable Plaque Induction

(1)

Models of Spontaneous Vulnerable Plaque Development

(1)

Novel Small Animal Models of Vulnerable Plaque

(5)

Models of Vulnerable Plaque Induction

(1)

Novel Transgenic Models of Spontaneous Vulnerable Plaque Development

(4)

Limitations and Future Directions

(1)

Concluding Remarks

(6)

References

(6)

Diagnosis of Vulnerable Plaques in the Cardiac Catheterization Laboratory

(14)

Johannes A. Schaar

Evelyn Regar

Chourmouzios A. Arampatzis

Arjen R.A. van der Ven

Cornelis J. Slager

Frank J. Gijsen

Jolanda J. Wentzel

Pim J. de Feyter

A.F.W. van der Steen

Patrick W. Serruys

Introduction

(1)

Angiography

(1)

Angioscopy

(1)

Intravenous Coronary Ultrasound

(2)

Intravascular Elastography and Palpography

(1)

Thermography

(1)

Optical Coherence Tomography

(1)

Raman Spectroscopy

(1)

Near-Infrared Spectroscopy

(1)

Magnetic Resonance Imaging

(1)

ANGUS and Shear Stress

(2)

Concluding Remarks

(5)

References

(5)

Imaging of High-Risk Atherosclerotic Plaque by Intravascular Ultrasound: Focal Assessment of Morphology and Vulnerability or Systemic Assessment of Disease Burden and Activity?

(18)

Paul Schoenhagen

Richard D. White

Steven E. Nissen

Introduction

(1)

Focal Assessment of Lesion Morphology and Vulnerability: A Paradigm Derived from Postmortem Studies

(2)

Evidence of a Multifocal, Systemic Disease Process: Impact on Existing Diagnostic and Therapeutic Paradigms

(3)

Systemic Assessment of Coronary Atherosclerotic Disease Burden and Activity: An Emerging New Paradigm

(4)

Concluding Remarks: Imaging of Vulnerable Plaques: Need for Prospective Trials

(8)

References

(7)

Optical Coherence Tomography for Detection of Vulnerable Plaque

(16)

Fabian Moselewski

Stephan Achenbach

Ik-Kyung Jang

Introduction

(1)

Pathophysiology of Plaque Disruption and Rationale for High Resolution Imaging

(1)

Technical Principles of Optical Coherence Tomography

(3)

Characterization of Atherosclerotic Plaque

(2)

Ex Vivo Validation

(1)

Fibrous Cap Imaging

(1)

Macrophage Detection in Vulnerable Plaques

(1)

Animal Experiment

(1)

In Vivo Validation

(2)

In Vivo Evaluation of Intracoronary Stents

(1)

Limitations of OCT

(1)

Concluding Remarks

(5)

References

(3)

Magnetic Resonance Imaging of High-Risk Plaque

101

(28)

Stephen G. Worthley

Juan J. Badimon

Introduction

101

(2)

Pathogenesis of Atherothrombosis

103

(2)

Magnetic Resonance Imaging

105

(7)

MRI Basics

105

(1)

Technical Considerations

105

(1)

Spin Echo Sequences

106

(2)

Gradient Echo Sequences

108

(3)

Patient Safety

111

(1)

MRI of Atherosclerosis

112

(8)

Ex Vivo MRI Plaque Studies

113

(1)

MR Multicontrast Plaque Imaging

113

(1)

In Vivo MRI Experimental Studies

114

(3)

In Vivo MRI Studies on Human Carotid Artery Plaque

117

(1)

In Vivo MRI Studies on Human Aortic Plaque

118

(1)

In Vivo MRI Studies on Coronary Artery Plaque

119

(1)

Targeted MRI

120

(2)

Concluding Remarks

122

(7)

References

122

(7)

Nuclear Imaging of the Vulnerable Plaque: Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET)

129

(16)

John Davies

James Rudd

Tim Fryer

Jonathan Gillard

Peter Weissberg

Introduction

130

(1)

Cellular and Molecular Biology of the Vulnerable Plaque: Important Aspects Related to Imaging

130

(1)

Basic Principles of Nuclear Imaging

131

(3)

Gamma Emission Nuclear Imaging

131

(1)

Positron Emission Nuclear Imaging

132

(2)

Imaging of Atherothrombosis with Gamma Emitting Isotopes

134

(5)

Imaging of Atherosclerotic Plaque with Gamma Emitting Isotopes

134

(3)

Imaging of Thrombi with Gamma Emitting Isotopes

137

(2)

Imaging of Atherosclerotic Plaques with Positron Emitting Isotopes

139

(3)

Experimental Atherosclerosis

139

(1)

Human Atherosclerosis

140

(2)

Concluding Remarks

142

(3)

References

142

(3)

Identification of Vulnerable Plaques: The Role of Thermography

145

(16)

Konstantinos Toutouzas

Sophia Vaina

Christodoulos Stefanadis

Introduction

145

(1)

Catheter-Based Devices for Coronary Temperature Measurements

146

(2)

Temperature Measurements of Human Atherosclerotic Plaques

148

(4)

Thermography and Inflammation

149

(1)

Thermography and Morphological Characteristics

150

(1)

Temperature Measurements and Blood Flow

150

(1)

Temperature of Culprit Atheromatous Plaque as a Prognostic Marker

151

(1)

From Vulnerable Plaque to Vulnerable Patient

152

(4)

Coronary Thermography for Widespread Inflammation

152

(1)

Beyond the Vulnerable Plaque: Coronary Sinus Thermography

153

(3)

Thermography-Guided Selection of Treatment

156

(1)

Experimental Studies

156

(1)

Future Perspectives

157

(1)

Concluding Remarks

158

(3)

References

158

(3)

Treatment of Vulnerable Plaques: Current and Future Strategies

161

(42)

Leonard Kritharides

David Brieger

S. Benedict Freedman

Harry C. Lowe

Detection of Patients with Vulnerable Plaques (VPs)

162

(4)

Introduction

162

(1)

At-Risk Patients and Myocardial Ischemia

163

(1)

Biochemical Markers

164

(1)

Identification of Individual Vulnerable Plaques

165

(1)

Current Therapeutics: Local and Systemic Approaches

166

(12)

Introduction

166

(1)

Percutaneous Coronary Intervention (PCI or PTCA) and Surgery

166

(1)

PCI for NonST Elevation Myocardial Infarction (NSTEMI)

166

(2)

PCI for Acute Myocardial Infarction (AMI)

168

(1)

PCI for VP

168

(1)

Surgery

169

(1)

Antiplatelet Agents

169

(1)

Aspirin

170

(1)

Thienopyridines

170

(2)

Platelet GP IIb/IIIa Inhibitor Therapy

172

(1)

Anticoagulants and Antithrombotics

173

(1)

Lipid Lowering Drugs and Their Pleiotropic Effects

173

(1)

HMG CoA-Reductase Inhibitors (Statins) Reduce the Incidence of Myocardial Infarction

173

(1)

Pleiotropic Effects of Statins

174

(1)

Statins and Inflammation

175

(1)

Statins, Endothelial Function, and eNOS

176

(1)

Effects in Atherosclerotic Tissue Relevant to VP

176

(1)

Lessons from Statins in Designing Future Therapies: Angiogenesis

176

(1)

Fibrates and PPAR Agonists

177

(1)

Novel Treatment Strategies

178

(10)

PPAR Agonists

178

(1)

PPAR-α

178

(1)

PPAR-γ

179

(1)

PPAR-δ

179

(1)

Combinations of Statins and Fibrates and Implications for PPARs

180

(1)

Accelerated Plaque Regression and Stabilization Using High Density Lipoprotein (HDL) and HDL-Like Molecules

180

(1)

HDL and Atherosclerosis

180

(1)

HDL: Mechanisms of Action

181

(1)

Prospects for Therapeutic Administration of Exogenous HDL or HDL-Like Molecules

182

(1)

Prospects for Targeted Elevation of HDL by Pharmacological Agents

182

(1)

Antiapoptotic Therapy

183

(1)

Proteases

184

(2)

Tissue Factor (TF)

186

(1)

Antibiotics

186

(1)

Gene Therapy

187

(1)

Concluding Remarks

188

(15)

Abbreviations

189

(1)

References

189

(14)

Index

203

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High-Risk Atherosclerotic Plaques: Mechanisms, Imaging, Models, and Therapy

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