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Atherosclerosis is traditionally viewed as a disease of uncontrolled plaque growth leading to arterial occlusion. More
recently, however, occlusion of the arterial lumen is being viewed as an acute event triggered by plaque rupture and
thrombosis. An atheromatous plaque becomes vulnerable to sudden activation and/or rupture when a constellation of
processes are activated by various trigger mechanisms. There is growing evidence that the vulnerability (i.e.
susceptibility to rupture) and thrombogenic nature of the plaque need to be taken into account in the planning and
treatment of the disease. X-ray fluoroscopy and intravascular ultrasound, the current clinical diagnostic tools are not
capable of the providing a complete histological picture of the plaque region.
Intravascular diagnostic imaging of coronary atherosclerotic plaques by optical means to assess plaque, patient risk and
assist in planning treatment strategies represents the future in angioplasty treatment by interventional cardiologists. The
techniques which will enable a clinically acceptable and reliable intravascular diagnostic platform are currently being
investigated and compared to the clinical standard of histology.
Currently, we are investigating the use of a number of optical and imaging techniques for biochemical analysis of
arterial tissue including Raman, near infrared and fluorescence spectroscopies. Biochemical imaging will provide
compositional information on collagen, elastin, lipid and thrombogenic by-products as well as gauging inflammation
and tissue remodeling activity levels. To complement the functional biochemical imaging, optical coherence
tomography will be provide structural morphological imaging. The synergistic combination of functional and structural
imagery will provide the interventional cardiologist with a complete clinical picture of the atherosclerotic plaque region.
The clinician can use this diagnostic information to plan a personalized treatment procedure based on the entire clinical
presentation.
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