Imaging of atherosclerotic plaque using radiofrequency ultrasound signal processing

The last 2 decades have seen many important enhancements in coronary arteriography and gray-scale IVUS. However, with standard angiographic and IVUS assessment, the morphologic assessment of coronary plaque composition is limited, precluding accurate identification of plaque types prone to rupture and produce ACS. New developments based on the processing of the backscattered radiofrequency IVUS signals offer new insights into plaque characterization and tissue identification. From the "soft" versus "hard" coronary plaque characterization of early gray-scale imaging, we now may be able to recognize TCFAs before rupture and calculate the volume of fibro-fatty plaque or the size of a necrotic core. Ongoing large multicenter investigations will determine whether these new parameters will improve on the detection of rupture-prone plaques and more accurately characterize longitudinal changes in plaque composition with antiatherogenic therapies. Perhaps of most importance, the prophylactic identification of the rupture-prone plaque represents the first step toward targeting therapies to high-risk patients and lesions to prevent ACS, acute myocardial infarction, and sudden death.[PUBLICATION ABSTRACT]