Vulnerable plaque

Vulnerable plaque refers to a kind of atherosclerotic plaque that is susceptible to rupture, which can lead to serious cardiovascular events such as myocardial infarction (heart attack) or stroke.

Overview

Vulnerable plaques are typically found in the coronary arteries, but can also occur in other blood vessels throughout the body. They are characterized by a thin fibrous cap that covers a large lipid core, making them more prone to rupture compared to stable plaques. The rupture of a vulnerable plaque can lead to the formation of a blood clot (thrombus), which can block blood flow and cause a heart attack or stroke.

Pathophysiology

The formation of a vulnerable plaque involves several steps. Initially, lipoproteins (such as LDL cholesterol) accumulate in the artery wall, leading to the formation of a fatty streak. Over time, this fatty streak can evolve into a fibrous plaque, characterized by a lipid core covered by a fibrous cap. Inflammatory cells, such as macrophages and T cells, infiltrate the plaque and release proteases that can weaken the fibrous cap, making it more prone to rupture.

Diagnosis

The diagnosis of vulnerable plaque is challenging, as these plaques often do not cause symptoms until they rupture. Several imaging techniques, such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and magnetic resonance imaging (MRI), can be used to identify vulnerable plaques. However, these techniques are invasive and not routinely used in clinical practice.

Treatment

The treatment of vulnerable plaque involves lifestyle modifications, such as diet and exercise, and medications to lower cholesterol levels and reduce inflammation. In some cases, angioplasty or stent placement may be necessary to restore blood flow.

File:Vulnerable plaque.jpg

Vulnerable plaque in a coronary artery. Image courtesy of Wikimedia Commons.

See also

• Atherosclerosis
• Coronary artery disease
• Heart attack
• Stroke

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