Handbook of the Vulnerable Plaque
http://www.100md.com
《新英格兰医药杂志》
Angiographic observations in the early 1980s confirmed that acute coronary thrombosis was the proximate cause of acute myocardial infarction — seminal studies that led to revolutionary treatments for the recanalization of occluded vessels. However, during the subsequent decades, the results of basic and clinical investigation have shown that the coronary clot is predominantly a secondary phenomenon; the true culprit in unstable ischemic heart disease is rupture of the underlying vulnerable atherosclerotic plaque.
Color-Enhanced Photomicrograph of an Artery with Plaque.
Wellcome Photo Library.
Handbook of the Vulnerable Plaque was edited by two distinguished leaders in interventional cardiology, Patrick Serruys and Ron Waksman. They assembled a who's who of authors in the field to write 24 chapters covering the pathology, pathophysiology, detection, and treatment of vulnerable plaque in the coronary vasculature. The introductory chapter, which reviews concepts and definitions, is followed by a superb contribution on the role of platelets in plaque vulnerability. An outstanding chapter on pathology provides the anatomical basis for an understanding of the data from noninvasive and invasive imaging techniques (which constitute the primary focus of the book). There is a very helpful chapter on animal models, and the chapter on genetic determinants is an authoritative and scholarly review of the most fundamental underpinnings of the science. The latter chapter, together with one on treatment paradigms from molecules in peripheral blood, clearly heralds the future of the field, which is destined to continue to evolve from a focus on the vascular lumen and wall to one that is founded on genetic and molecular medicine.
Most of the book is devoted to both noninvasive and invasive techniques for the detection of vulnerable plaque. There are chapters on the established invasive imaging tools of selective coronary angiography and intravascular ultrasonography. New catheter-based techniques (including thermography, optical coherence tomography, near-infrared spectroscopy, and elastography) are considered in separate chapters. Two excellent chapters delve into the noninvasive imaging of vulnerable plaque. The discussion of magnetic resonance imaging is a definitive review of the topic. In a similar vein, the chapter on multislice computed tomographic angiography is an excellent review of the coronary-imaging potential of this noninvasive technique. Given that the vast majority of patients who are at risk for coronary disease or who have clinical symptoms will never make it into a catheterization laboratory for invasive evaluation, the chapters on noninvasive procedures nicely complement those on invasive procedures.
Three chapters consider the treatment of vulnerable plaque, including a fine review of pharmacologic interventions. Two chapters on catheter-based therapies discuss the role of drug-eluting stents (as a "preemptive strike" against plaques that are vulnerable but not flow-limiting) and photodynamic therapy.
My chief criticism of this book is that the chapters on new catheter-based imaging techniques are redundant and that these techniques perhaps receive a disproportionate emphasis. For example, four chapters are devoted to thermography and three others to optical coherence tomography; a future edition (and I hope there is one) might consider one comprehensive chapter on each tool. Additional items I would like to see in a second edition include a comprehensive overview of the pathophysiology of plaque vulnerability and a discussion of vulnerable plaque outside the coronary circulation and its relationship with the instability of coronary plaque.
These minor criticisms aside, Handbook of the Vulnerable Plaque is the most comprehensive assessment available in the field. Small in size, it is printed on fine paper, is easy to read, and contains numerous illustrations of imaging scans and pathological specimens that are of the finest quality.
James Goldstein, M.D.
William Beaumont Hospital
Royal Oak, MI 48073
jgoldstein@beaumont.edu
Color-Enhanced Photomicrograph of an Artery with Plaque.
Wellcome Photo Library.
Handbook of the Vulnerable Plaque was edited by two distinguished leaders in interventional cardiology, Patrick Serruys and Ron Waksman. They assembled a who's who of authors in the field to write 24 chapters covering the pathology, pathophysiology, detection, and treatment of vulnerable plaque in the coronary vasculature. The introductory chapter, which reviews concepts and definitions, is followed by a superb contribution on the role of platelets in plaque vulnerability. An outstanding chapter on pathology provides the anatomical basis for an understanding of the data from noninvasive and invasive imaging techniques (which constitute the primary focus of the book). There is a very helpful chapter on animal models, and the chapter on genetic determinants is an authoritative and scholarly review of the most fundamental underpinnings of the science. The latter chapter, together with one on treatment paradigms from molecules in peripheral blood, clearly heralds the future of the field, which is destined to continue to evolve from a focus on the vascular lumen and wall to one that is founded on genetic and molecular medicine.
Most of the book is devoted to both noninvasive and invasive techniques for the detection of vulnerable plaque. There are chapters on the established invasive imaging tools of selective coronary angiography and intravascular ultrasonography. New catheter-based techniques (including thermography, optical coherence tomography, near-infrared spectroscopy, and elastography) are considered in separate chapters. Two excellent chapters delve into the noninvasive imaging of vulnerable plaque. The discussion of magnetic resonance imaging is a definitive review of the topic. In a similar vein, the chapter on multislice computed tomographic angiography is an excellent review of the coronary-imaging potential of this noninvasive technique. Given that the vast majority of patients who are at risk for coronary disease or who have clinical symptoms will never make it into a catheterization laboratory for invasive evaluation, the chapters on noninvasive procedures nicely complement those on invasive procedures.
Three chapters consider the treatment of vulnerable plaque, including a fine review of pharmacologic interventions. Two chapters on catheter-based therapies discuss the role of drug-eluting stents (as a "preemptive strike" against plaques that are vulnerable but not flow-limiting) and photodynamic therapy.
My chief criticism of this book is that the chapters on new catheter-based imaging techniques are redundant and that these techniques perhaps receive a disproportionate emphasis. For example, four chapters are devoted to thermography and three others to optical coherence tomography; a future edition (and I hope there is one) might consider one comprehensive chapter on each tool. Additional items I would like to see in a second edition include a comprehensive overview of the pathophysiology of plaque vulnerability and a discussion of vulnerable plaque outside the coronary circulation and its relationship with the instability of coronary plaque.
These minor criticisms aside, Handbook of the Vulnerable Plaque is the most comprehensive assessment available in the field. Small in size, it is printed on fine paper, is easy to read, and contains numerous illustrations of imaging scans and pathological specimens that are of the finest quality.
James Goldstein, M.D.
William Beaumont Hospital
Royal Oak, MI 48073
jgoldstein@beaumont.edu