The role of near-infrared spectroscopy in the detection of vulnerable atherosclerotic plaques

Martin Horvath, Petr Hajek, Cyril Stechovsky, Jakub Honek, Miloslav Spacek, Josef Veselka, Martin Horvath, Petr Hajek, Cyril Stechovsky, Jakub Honek, Miloslav Spacek, Josef Veselka

Abstract

Coronary artery disease is the leading cause of mortality worldwide. Most acute coronary syndromes are caused by a rupture of a vulnerable atherosclerotic plaque which can be characterized by a lipid-rich necrotic core with an overlying thin fibrous cap. Many vulnerable plaques can cause angiographically mild stenoses due to positive remodelling, which is why the extent of coronary artery disease may be seriously underestimated. In recent years, we have witnessed a paradigm shift in interventional cardiology. We no longer focus solely on the degree of stenosis; rather, we seek to determine the true extent of atherosclerotic disease. We seek to identify high-risk plaques for improvement in risk stratification of patients and prevention. Several imaging methods have been developed for this purpose. Intracoronary near-infrared spectroscopy is one of the most promising. Here, we discuss the possible applications of this diagnostic method and provide a comprehensive overview of the current knowledge.

Keywords: lipid-core plaque; near-infrared spectroscopy; vulnerable plaque.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The results of NIRS are presented on a colour-coded probability map called a “chemogram”. Every pixel represents the probability of lipid presence at the given location on a colour scale in which low probabilities of lipids are depicted as red, and high probabilities of lipids are shown as yellow. The X-axis of the chemogram indicates the pullback position in millimetres, and the Y-axis indicates the circumferential position in degrees as though the coronary vessel had been split open along its longitudinal axis
Figure 2
Figure 2
Panel A reveals the intravascular ultrasound (IVUS) image of a lesion in the left anterior descending artery prior to percutaneous coronary intervention (PCI). The near-infrared spectroscopy (NIRS) chemogram obtained before PCI reveals two lipid cores (B). A coronary angiogram of the lesion is provided (C). A second IVUS image acquired after the PCI shows good apposition of the stent (D). The second NIRS chemogram documented complete disappearance of the lipid cores during the dilation of the lesion (E). A good angiographic result is shown in panel F

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