SHAPE Society

2. Thermography
intravascular
MR
Optical Coherence Tomography
Angioscopy
Near IR
Catheter-based Detection of
Vulnerable Plaque
IVUS
JTS
Nuclear

3. 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

4. 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

5. 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.

6. 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%

7. 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

8. 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