The Vulnerable Atherosclerotic Plaque: Understanding, Identification, and Modification / Edition 1

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Overview

In the late 1950s, atherosclerotic lesions in the arteries were intensely scrutinised at autopsy by the Committee on Vascular Lesions, a creative forum that became part of the American Heart Association in 1959. By the early 1980s, concerned efforts brought many medical subspecialties together to quantify treatments of atherosclerosis in the living, by comparing results and standardising on measurements and terms deployed. With improved understandings about the vascular wall, the Committee was able to develop a classification of atherosclerotic lesions.

This work reveals critical understandings about the natural history of plaque, the correlation of vascular lesions and clinical syndromes, and the utility of new imaging methods. Diagnostic imaging, atherosclerosis prevention and treatment will be shaped by these new modalities. Continuous scrutiny by the Committee is culminating in scientific meetings every few years, and is summarised in published statements. The present statement The Vulnerable Atherosclerotic Plaque: Understanding, Identification and Modification is the second of these documents to focus on atherosclerosis pathogenesis and pathological clinical implications.

As a multi-disciplinary resource, this book edited by Valentin Fuster, MD, PhD, chairman of the committee, consists of twenty four chapters written by experts in mechanical and electrical engineering, pathology, neurology, imaging, clinical and vascular biology, physics, radiology and surgery. This invaluable reference tool identifies problems, perspectives and critical new questions for evaluation and dissemination.

The book contains predominantly black-and-white illustrations, with some color illustrations.

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Editorial Reviews

Doody's Review Service
Reviewer: John F. Moran, MD (Loyola University Stritch School of Medicine)
Description: This text is another in the American Heart Association Monograph Series. It is the result of a meeting of the Committee of the American Heart Association Council on Atherosclerosis which occurs about every two years. It is a multi-authored text that features experts in pathology, imaging, and clinical and vascular biology.
Purpose: The purpose is to provide a multi-disciplinary approach to studying atherosclerosis, which will lead to a better understanding of the disease process. The committee hopes to make a statement every two years or so and disseminate the available knowledge and insight into atherosclerosis.
Audience: This text is an excellent review of the subject that will be of value to researchers and graduate student as well as cardiovascular practitioners and trainees in cardiology.
Features: The text begins with a description of the vulnerable plaque and the interaction it has with acute thrombus. Coronary angiography can identify significant plaque formation but does not identify the plaque more likely to occlude. In fact, several studies now show that two-thirds of coronary artery occlusions occur in areas where the plaque obstruction was less than 50%. This book contains current chapters on intravascular ultrasound, angioscopy, ultrafast computerized tomography, magnetic resonance imaging, and thermography. These imaging techniques are all attempts to identify the plaque most likely to occlude the artery. The text is grouped into six sections with up to seven chapters in each section. Each section is followed by a panel discussion involving the contributors as well as members of the audience. This is quite helpful. The shortcomings of this text are basically the shortcomings of our insight into atherosclerosis.
Assessment: There are four insightful chapters on the mechanics of plaque disruption. The final three chapters take up some of the present and future directions of research in this area. Currently our management of these patients should involve antithrombotic aspirin and the cholesterol-lowering 'statin' drugs. However, the future management of atherosclerotic plaque from description to detection to treatment looks very promising. This book is a welcome contribution to the field.
From the Publisher
"...timely and important...All aspects of the subject are well covered by recognized experts from a wide variety of disciplines including pathology, imaging, clinical medicine and vascular biology.
"The present publication is another extremely valuable contribution to the literature on this subject."

Canadian Journal of Cardiology

"Dr. Valentin Fuster has assembled an impressive array of contributors, many of whom have made seminal contributions to this field.
"...a gem of a book that should be read by any clinician or scientist with an interest in this area."

Annals of Vascular Surgery

"In summary, a detailed yet tolerable overview of the current concepts related to atherosclerotic disease and plaque rupture is presented. Chapters are well written, concise, and contain extensive reference sections for those who want to proceed with a more intense scrutiny of a particular topic. This text outlines the strategies we will use to evaluate and treat atherosclerosis in the next decade. It is important reading for surgeons, internists, radiologists, and the basic scientists with an interest in the treatment of vascular disease."

Journal of Vascular Surgery

"This text is an excellent review of the subject that will be of value to researchers and graduate students as well as cardiovascvular practitioners and trainees in cardiology.
"...the future management of atherosclerotic plaque from description to detection to treatment looks very promising. This book is a welcome contribution to the field."

Doody’s Review Service

John F. Moran
This text is another in the American Heart Association Monograph Series. It is the result of a meeting of the Committee of the American Heart Association Council on Atherosclerosis which occurs about every two years. It is a multi-authored text that features experts in pathology, imaging, and clinical and vascular biology. The purpose is to provide a multi-disciplinary approach to studying atherosclerosis, which will lead to a better understanding of the disease process. The committee hopes to make a statement every two years or so and disseminate the available knowledge and insight into atherosclerosis. This text is an excellent review of the subject that will be of value to researchers and graduate student as well as cardiovascular practitioners and trainees in cardiology. The text begins with a description of the vulnerable plaque and the interaction it has with acute thrombus. Coronary angiography can identify significant plaque formation but does not identify the plaque more likely to occlude. In fact, several studies now show that two-thirds of coronary artery occlusions occur in areas where the plaque obstruction was less than 50%. This book contains current chapters on intravascular ultrasound, angioscopy, ultrafast computerized tomography, magnetic resonance imaging, and thermography. These imaging techniques are all attempts to identify the plaque most likely to occlude the artery. The text is grouped into six sections with up to seven chapters in each section. Each section is followed by a panel discussion involving the contributors as well as members of the audience. This is quite helpful. The shortcomings of this text are basically the shortcomings of our insightinto atherosclerosis. There are four insightful chapters on the mechanics of plaque disruption. The final three chapters take up some of the present and future directions of research in this area. Currently our management of these patients should involve antithrombotic aspirin and the cholesterol-lowering 'statin' drugs. However, the future management of atherosclerotic plaque from description to detection to treatment looks very promising. This book is a welcome contribution to the field.
Booknews
Comprises a collection of research papers from the Committee on Vascular Lesions of the American Heart Association on factors influencing the natural history of plaques; the correlation of vascular lesions and clinical syndromes, including their underlying pathogenesis; and the utility of new methods of imaging for the evaluation of atherosclerotic disease. Various aspects of these issues are discussed in 24 international contributions and six panel discussions. Annotation c. by Book News, Inc., Portland, Or.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780879934064
  • Publisher: Wiley
  • Publication date: 1/28/1999
  • Series: American Heart Association Monograph Series
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 446
  • Product dimensions: 6.34 (w) x 9.30 (h) x 1.00 (d)

Table of Contents

Historical Perspective: The Vascular Lesions Committee of The American Heart Association.

1. Coronary Artery Disease: Plaque Vulnerability, Disruption, and Thrombosis.

S. Dalager-Pederson, E. Morre Pederson, S. Ringgard, E. Falk.

2. Pathobiology of Symptomatic Carotid Atherosclerosis.

H.S. Bassiouny, Y. Sakaguchi, C.A. Goudet, R. Vito, S. Glagov.

3. The Vulnerable Plaque: Aortic Disease.

I.N. Hamilton, L.H. Hollier.

Panel Discussion I. Overview of Pathology: The Vulnerable Plaque and Complications of Atherosclerosis.

4. Coronary Angiography and the Vulnerable Plaque.

D. Waters.

5. Detection of Atherosclerosis and Identification of Vulnerable Plaque: Potential Role of Intravascular Ultrasound.

S.E. Nissen, K. Ziada, E.M. Tuzcu.

6. Angioscopic Detection of Vulnerable Plaques and Predication of Acute Coronary Syndromes.

Y. Uchida.

7. Ultrafast Computed Tomography in Coronary Heart Disease.

A.D. Guerci.

Panel Discussion II. Overview of Imaging: Characterisation of the Vulnerable Plaque with Emphasis on Coronary Atherosclerosis.

8. Magnetic Resonance Imaging of the Vessel Wall in Carotids and Coronaries.

M. Shannar, Z.A. Fayad, J.T. Fallon, V. Fuster.

9. Tissue Characterisation of Human Atherosclerosis and Plaque Vulnerability by Nuclear Magnetic Resonance.

J-F. Toussaint, V. Fuster.

10. Coronary and Carotid Magnetic Resonance Imaging.

R.R. Edelman.

11. Aortic Arch Vulnerable Plaques.

P. Amarenco, A. Cohen.

12. Radioisotopic Imaging of Atheroma.

S. Vallabhajosula.

13. Thermography.

W. Casscells, M. David, G. Bearman, F. Clubb, J.G. Fujimoto.

14. Cardiovascular Imaging with Optical Coherence Tomography.

M.E. Brezinski, G.J. Tearney, J.F. Southern, J.G. Fujimoto.

Panel Discussion III. Overview of Imaging: Characterisation of the Vulnerable Atherosclerotic Plaque with Emphasis on Other Atherosclerotic Regions and Imaging Modalities.

15. De Novo Atherosclerotic Geometric Remodelling and Plaque Vulnerability.

G. Pasterkamp.

16. Lipids in Atherosclerotic Lesion Progression.

J.R. Guyton.

17. Extracellular Matrix of the Vulnerable Atherosclerotic Plaque.

W.D. Wagner.

Panel Discussion IV. Structural and Cellular Components of the Vulnerable Plaque.

18. Mechanical Stress and Strain and the Vulnerable Atherosclerotic Lesion.

L. Rohde, R.T. Lee.

19. Hemodynamic Aspects of Plaque Disruption.

D.N. Ku, S. Biz, J.M. Downing, S. Glagov.

20. Effect of Rheology on Thrombosis.

J.J. Badimon, L. Badimon, V. Fuster.

21. The Potential Role of Endothelium in Acute Coronary Syndromes: Vasomotion, Inflammation, Thrombosis.

S. Kinlay, A.P. Selwyn, P. Ganz.

Panel Discussion V. Mechanical Forces in Plaque Disruption.

22. Regulation of Metalloproteinases and their Inhibitors in Atheroma.

R.P. Fabunmi, P. Libby.

23. New Concepts in Regulation of Vascular Calcification.

F. Parhami, L.L. Demer.

24. Plaque Stabilisation: Present and Future Trends.

V. Fuster.

Panel Discussion VI. Functional Components of the Vulnerable Plaque

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