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168 catheter based detection of vulnerable plaque


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SHAPE Society

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168 catheter based detection of vulnerable plaque

  1. 1. Thermography intravascular MR Optical Coherence Tomography Angioscopy Near IR Catheter-based Detection of Vulnerable Plaque IVUS JTS Nuclear
  2. 2. Types of Studies for Validation of VP ( inflamed TCFA) Dx and Rx • Autopsy Specimens •Animal Models •Short-Term Chol-fed Rabbits •Long-Term Chol-fed Rabbits •Pig •Human Studies •Disrupted Plaque study •Natural History of Suspected VP Study •Treatment Study •Cost-effectiveness Study
  3. 3. The likelihood that a given plaque will disrupt and cause a clinical event (death, MI, documented increase in ischemia) within one year. Plaque Vulnerability Clinical Index -- The Vulnerable Patient
  4. 4. Plaque Vulnerability Angiographic Index The likelihood that a given plaque will disrupt and produce a thrombus, leading to a significant increase in stenosis or decrease in MLD (greater than 50% absolute increase by QCA, or .4mm MLD decrease) within a fixed period.
  5. 5. Progression of Coronary Lesions (Minimum lesion diameter decrease of .4mm over 2.5 years ) 0 10 20 30 40 50 60 Fluvastatin n = 117 Placebo n= 168 Progress Regress Mixed Herd et al AJC 1997 % of Pts Events only 14%
  6. 6. Rx of VP Trial of Detection and Treatment of Vulnerable Plaque 1000 patients with angina undergoing PTCA/ Stenting Vulnerability Detector 100 Patients with VP 900 Patients without VP Randomize No Rx of VP 1 yr F.U. MI SCD
  7. 7. Clinical Utilization of the Plaque Vulnerability Index Screen the General Population By Conventional Risk Factors (Age, Gender, FH, etc) Vulnerable Patients by blood test Vulnerable Patients and ?Vulnerable Plaques by Non- invasive assessment Plaque Vulnerability Index by Invasive Assessment