“Vulnerable plaques”:  inflammation, blood viscosity and risk of cardiovascular events

Vascular lesions in atherosclerosis have different risk of leading to a major event, which is most often (athero-)thrombotic. Not the degree of stenosis determines highest risk, but the presence of inflammatory activity and a large soft central lipid core covered with a thin fibrous cap. (1)

These lesions are considered to be “vulnerable plaques” (Figure 1) which are prone to rupture, leading to an atherothrombotic cascade, often culminating in a complete obstruction of the vessel or incomplete obstruction with spread of  micro-embolism form the ruptured plaque, both resulting in subsequent tissue necrosis in the flow-related area.
Extensive efforts are going on to detect these “vulnerable plaques” by intravascular ultrasound, thermal detection, spectroscopy, etc. (2) Instead of detecting  the often multiple “vulnerable plaques”, our goal is to reduce the imminent thread of rupture by reducing the mechanical stress on these endovascular sites. While vascular lesions in atherosclerosis usually occur at sites of low shear, high shear conditions finally determine whether these lesions destabilize into rupture-prone “vulnerable plaques”. (3)
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