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The Role of Virtual Histology Intravascular Ultrasound in the Identification of Coronary Artery Plaque Vulnerability in Acute Coronary Syndromes

Sinclair, Hannah BSc, MBChB, MRCP; Veerasamy, Murugapathy MBBS, MRCP; Bourantas, Christos MD, PhD; Egred, Mohaned BSc, MBChB, MD, FRCP, FESC; Nair, Anuja MS; Calvert, Patrick A. BM BCh, MA, PhD, MRCP, FACC; Brugaletta, Salvatore MD; Mintz, Gary S. MD; Kunadian, Vijay MBBS, MD, FRCP, FACC, FESC

doi: 10.1097/CRD.0000000000000100
Review Articles
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Markers of coronary plaque vulnerability, such as a high lipid burden, increased inflammatory activity, and a thin fibrous cap, have been identified in histological studies. In vivo, grayscale intravascular ultrasound (IVUS) provides more in-depth information on coronary artery plaque burden than conventional angiography but is unable to accurately distinguish between noncalcific tissue types within the plaque. An analysis of IVUS radiofrequency backscatter based on spectral pattern recognition, such as virtual histology IVUS, allows detailed scrutiny of plaque composition and classification of coronary lesions. This review discusses the virtual histology IVUS technology and its accuracy in identifying vulnerable plaque features, focusing on its use in predicting patient outcomes after acute coronary syndrome, and its limitations in clinical practice.

From the *Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom; Volcano Corporation, San Diego, CA; §Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Cardiology, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain; and **Division of Cardiology, Cardiovascular Research Foundation, New York, NY.

Disclosure: Anuja Nair is an employee of Volcano Corporation. The other authors have no conflicts of interest to report.

Correspondence: Vijay Kunadian, MBBS, MD, FRCP, FACC, FESC, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, 3rd Floor William Leech Building, Newcastle upon Tyne NE2 4HH, United Kingdom. E-mail. vijay.kunadian@newcastle.ac.uk.

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