Novel theranostic approaches to neovascularized atherosclerotic plaques

Atherosclerosis is an inflammatory vascular disease characterized by focal thickening of the artery walls due to plaque buildup. While generally silent, disease progression can lead to serious acute outcomes when plaque ruptures and occludes coronary or carotid arteries. This can lead to myocardial infarction (MI), transient ischemic attack (TIA), and stroke, making atherosclerotic cardiovascular disease (ASCVD) one of the leading causes of death worldwide, including Canada [1]. Prognosis depends on traditional cardiac risk factors, and the extent of coronary and vascular atherosclerotic lesion development. The majority of cardiovascular events are caused by thromboembolism of unstable, or vulnerable, plaques [2]. These lesions are characterized by thin fibrous caps, large lipid cores, intraplaque hemorrhage, inflammation, and marked neovascularization [3,4]. There is a wealth of literature that correlates neovascularization to plaque vulnerability, and several groups have begun exploring plaque microvessels as a potential target to slow or reverse atherosclerotic disease progression. This review provides a comprehensive summary of the pathogenesis of neovascularization in atherosclerosis, its clinical significance, and the novel diagnostic and therapeutic strategies being developed.

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