Multimodality Imaging Atlas of Coronary Atherosclerosis

Abstract

NEW HIGH-RESOLUTION IMAGING TECHNOLOGIES HAVE ENHANCED OUR UNDERSTANDING OF THE CORONARY atherosclerotic disease process, and this atlas provides a multimodality pictorial review of the development of histologically verified coronary atherosclerosis. A modified American Heart Association classification scheme system based on morphological plaque features and the propensity of plaque for thrombosis or cause of sudden cardiac death has recently been proposed. This classification scheme incorporates 5 categories of coronary atherosclerotic lesions (Table 1) (1 and 2). These categories include nonatherosclerotic lesions (intimal thickening and intimal xanthoma) and progressive atherosclerotic lesions (pathological intimal thickening, fibroatheroma, thin fibrous cap atheroma, rupture, erosion, calcified nodule, and fibrocalcific plaque). The description of these categories is based on the accretion of lipid in relationship to fibrous cap formation, lipid pool transition into necrotic core, the thinning or thickening of fibrous cap, and presence of thrombosis. Furthermore, plaque characteristics such as angiogenesis, intraplaque hemorrhage, inflammation, calcification, cell death, and proteolysis are presented as descriptive terms along with features like culprit lesion associated with thrombus. This multimodality imaging atlas of ex vivo human hearts illustrates this morphological classification through computed tomography (CT), intravascular ultrasound (IVUS), optical frequency domain imaging (OFDI) and corresponding histological characteristics.