How to Look Closely to Vulnerable Atherosclerotic Plaques Using Nanoparticles

Coronary heart disease (CHD) continues to be a major cause of morbidity and mortality throughout the world [1]. Nearly two thirds of myocardial infarctions occur due to rupture and thrombosis of non-flow-limiting plaques in lesions that showed only moderate stenosis. The risk of rupture in nonstenotic plaques seems to depend more on plaque composition rather than plaque size or fibrous cap thickness solely. The vulnerable plaques are morphologically characterized by outward remodeling, increased plaque neovascularity, intraplaque hemorrhage, smooth muscle cell depletion and microcalcification. It is also descried that namely intimal and adventitial inflammation play a key role in plaque vulnerability, rupture and subsequent thrombosis, exposing that the plaque instability is intrinsically related to the atherosclerotic inflammatory process [2,3]. Detection of a vulnerable plaque and subsequent rupture prevention is a remaining challenge in cardiology. Mostly because the available diagnostic tools lack the molecular information and it is now clear that based in purely anatomic imaging it is difficult to predict an ACS [4]. Among the available diagnostic tools the intravascular imaging and molecular imaging probes are emerging as possible methods for this purpose, though none is available for accurately predict plaque rupture. In this mini-review we will focus on the most promising imaging tools combinations that can finally deliver a complete diagnose of plaque vulnerability.