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Coronary Atherosclerosis and Acute Coronary Syndrome: New Insights from Angioscopic Viewpoints

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Coronary angioscopy has visualized and elucidated the pathophysiology of various coronary artery diseases, especially, acute coronary syndrome (ACS). Culprit lesions of ACS can be diagnosed as the irregular-surfaced yellow plaques with a predominantly white thrombus. Yellow material covered by white thrombus is often observed protruding from the plaque, fragmented and washed away into the distal artery. This lipid-rich material mixed with white thrombus has been shown to cause distal embolization and no-reflow phenomenon, and has recently become the therapeutic target of distal protection devices. Angioscopy can easily detect vulnerable plaques as yellow plaques. We found that yellow plaques of higher yellow color intensity tended to have thrombosis more frequently. However, it may be difficult to find out a dangerous plaque from the whole coronary artery trees. The number of yellow plaques in a major coronary artery or the yellow color intensity of those plaques may be a marker of coronary atherosclerosis and may be a risk factor of ACS. We thought it would be easier to find out patients than plaques at high risk of ACS. We followed up 85 patients of acute myocardial infarction for about 5 years and found that patients who suffered another ACS event had more yellow plaques of higher yellow color intensity at baseline than those who did not. Direct visualization by angioscopy provides rather subjective information but may give some indication of the pathophysiology or the need for and success of treatment of coronary disease.
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Keywords: Coronary Atherosclerosis; angioscopy; thrombus

Document Type: Review Article

Affiliations: Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035 Japan.

Publication date: 2004-03-01

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  • Vascular Disease Prevention publishes reviews as well as original papers to update all those concerned with this topic at the clinical or scientific level. In addition to clinically relevant topics, we consider reviews and original papers dealing with the more scientific aspects of vascular disease prevention. This includes the evaluation of emerging vascular risk factors, research dealing with the pathogenesis of atherosclerosis and the investigation of new treatment options both at the clinical and scientific level (e.g. epidemiology, patient-based studies, experimental models, in vitro experiments or molecular research). Therefore, another function of Vascular Disease Prevention is to bridge the gap between clinical practice and ongoing laboratory-based research.

    In particular, we welcome critical reviews and comments on recent trials. This is a topic that requires regular updates because of the large number of trials published every year.

    Debates are encouraged in the correspondence section of this journal.
    The editorial structure of Vascular Disease Prevention is set up with the aim of dealing with the submitted material as rapidly as possible. Specialist editors will provide a more expert and rapid assessment unlike a more centralized editorial structure.
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