How is a vulnerable plaque clinically defined?
Coronary plaque rupture with superimposed thrombus is the proximate cause of acute coronary syndromes (ACS). “Vulnerable plaque” is the atherosclerotic lesion defined as the precursor to coronary plaque rupture. A frankly unstable, disrupted atherosclerotic plaque is characterized pathologically as an inflamed, thin-capped fibroatheroma (TCFA). Thrombus forms upon this disrupted plaque, leading to an abrupt reduction in coronary blood flow, clinically manifested as ACS, with the patient presenting with chest pain or other symptoms, EKG changes and often enzymatic biomarkers indicative of myocardial necrosis. In some cases, these disrupted plaques present as sudden cardiac death due to lethal arrhythmias. A key question is whether there are precursor stable, but “vulnerable,” plaques that transition to unstable lesions, which might be detectable prior to disruption with therapies designed to prevent ACS and sudden death. The concept of vulnerable plaque was first described by Dr. James
