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Review
. 2023 Oct 12:14:1159288.
doi: 10.3389/fneur.2023.1159288. eCollection 2023.

Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques

Zhiwei He  1 , Jiaying Luo  1 , Mengna Lv  1 , Qingwen Li  2 , Wei Ke  1 , Xuan Niu  1 , Zhaohui Zhang  1
Affiliations
Review

Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques

Zhiwei He et al. Front Neurol. .

Abstract

Atherosclerosis is an important cause of cerebrovascular and cardiovascular disease (CVD). Lipid infiltration, inflammation, and altered vascular stress are the critical mechanisms that cause atherosclerotic plaque formation. The hallmarks of the progression of atherosclerosis include plaque ulceration, rupture, neovascularization, and intraplaque hemorrhage, all of which are closely associated with the occurrence of CVD. Assessing the severity of atherosclerosis and plaque vulnerability is crucial for the prevention and treatment of CVD. Integrating imaging techniques for evaluating the characteristics of atherosclerotic plaques with computer simulations yields insights into plaque inflammation levels, spatial morphology, and intravascular stress distribution, resulting in a more realistic and accurate estimation of plaque state. Here, we review the characteristics and advancing techniques used to analyze intracranial and extracranial atherosclerotic plaques to provide a comprehensive understanding of atheroma.

Keywords: atherosclerosis; biomarker; imaging method; plaque analysis; quantitative evaluation; vulnerable plaque.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Inflammatory atherosclerosis, risk factors and subsequent complications. Traditional risk factors such as dyslipidemia, hyperglycemia, and hypertension play a crucial role in the development of atherosclerosis. Moreover, alterations in vascular blood flow, particularly abnormal WSS, contribute significantly to this pathological process. The presence of local inflammation in blood vessels is observed consistently throughout the progression of atherosclerosis, involving multiple cytokines and cell types. Ultimately, the rupture of atheromatous plaque in various arteries leads to the manifestation of diverse atherovascular diseases. HHcy, hyperhomocysteinemia; WSS, wall shear stress (Created with BioRender.com).
Figure 2
Figure 2
Biomarkers and parameters of atherosclerosis. Biomarkers, imaging parameters, biomechanical parameters, and anatomical parameters act as valuable indicators at distinct stages of atherosclerosis. Combining them to assess atheromatous plaques and vessels is fundamental and aids in predicting and guiding treatment. WSS, wall shear stress; IMT, intima-media thickening; LDL, low-density lipoprotein; GDF-15, growth differentiation factor 15; IPH, intraplaque hemorrhage; TPA, total plaque area; TPV, total plaque volume; WSSG, wall shear stress gradient; TA-WSS, time-averaged WSS; APS, the axial plaque stress; PR, pressure ratio; MMP, matrix metalloproteinase (Created with BioRender.com).
Figure 3
Figure 3
Distribution of atheromatous plaques. The distribution of atheromatous plaques varies across different arterial systems, leading to distinct characteristics in their evolution and outcomes. MCA, middle cerebral artery; BA, basilar artery; CCA, common carotid artery; ICA, internal carotid artery; LAD, left anterior descending coronary artery (Created with BioRender.com).
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Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (No. 82071183 to ZZ and No. 82001245 to XN).

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