Thermograph

y

intravascular MR

Optical Coherence Tomography

Angioscopy

Near IR

Catheter-based Detection of Vulnerable Plaque

IVUS

JTS

Nuclear

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

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

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.

Progression of Coronary Lesions(Minimum lesion diameter decrease of .4mmover 2.5 years )

0

10

20

30

40

50

60

Fluvastatin n = 117 Placebo n=168

ProgressRegressMixed

Herd et al AJC 1997

%ofPts

Events only 14%

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

Clinical Utilization of the Plaque Vulnerability Index

Screen the GeneralPopulationBy Conventional Risk Factors(Age, Gender,FH,etc)

VulnerablePatients bybloodtest

VulnerablePatientsand ?VulnerablePlaques by Non-invasiveassessment

PlaqueVulnerabilityIndex by InvasiveAssessment