Which is More Important: Plaque Quantity or Plaque Rupture?

William Roberts; Peter Libby; James de Lemos

Which is More Important: Plaque Quantity or Plaque Rupture?

Moderator:

William Clifford Roberts, MD

Baylor University Medical Center

Discussants:

Date: January 25, 2011

Roundtable ID: CV5082

Citation: Med Roundtable Cardiovasc Ed. ; 2(1): 41 - 47.

Summary:
Dr. William C. Roberts from the Baylor Heart and Vascular Institute moderated the topic "Which is More Important: Plaque Quantity or Plaque Rupture?" with Drs. James de Lemos from University of Texas Southwestern Medical Center and Peter Libby from the Brigham and Women's Hospital participating.

The discussion focused primarily on:

(1) vulnerable plaque focus over plaque quantity,

(2) defining characteristics of vulnerable plaque,

(3) techniques for diagnosing vulnerable plaque,

(4) the frequency of significant thrombus detection and clinical events,

(5) biomarkers and imaging technology for detecting vulnerable plaques,

(6) therapy for patients with atherosclerotic plaque or vulnerable plaques,

(7) the effects of lipid levels on therapy choices, and

(8) effect of heparin on ruptured plaque.

(Med Roundtable Cardiovasc Ed. 2011;2(1):41-47) ©2011 FoxP2 Media, LLC

Compounds:
No compounds discussed.

Trials:
ASCOT, JUPITER, MESA, PROSPECT

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“I try to avoid the term ‘vulnerable plaque’ because it implies that we possess a crystal ball that can tell the future of a particular lesion based solely on its morphology.”
~ Peter Libby, MD

“It really takes two to tango: it takes both a disordered solid state of the plaque and fluid phase of blood to set the stage for thrombotic occlusion.”
~ Peter Libby, MD

“From a biological perspective I think the reason [coronary calcium testing] works is because the best predictor of vulnerable plaque is having more overall plaque. This is a test that is specific for coronary plaque, and that is good.”
~ James de Lemos, MD

“It seems to me that the most common cause of plaque rupture today is coronary angioplasty with or without a stent insertion, and the next is a coronary bypass grafting.”
~ William C. Roberts, MD