vulnerable plaque
An atherosclerotic lesion prone to rupture despite not necessarily causing significant vessel narrowing, characterized by a thin fibrous cap and large lipid core.
Full Definition
Vulnerable plaque refers to atherosclerotic lesions that are at high risk for rupture, leading to acute cardiovascular events such as myocardial infarction or stroke. These plaques are characterized by a thin fibrous cap (<65 micrometers), large necrotic lipid core (>40% of total plaque area), increased macrophage infiltration, and reduced smooth muscle cell content. Paradoxically, vulnerable plaques may not cause significant luminal narrowing and can be missed on conventional angiography. Advanced imaging techniques such as intravascular ultrasound, optical coherence tomography, and magnetic resonance imaging can help identify these high-risk lesions. Therapeutic strategies focus on plaque stabilization through aggressive lipid lowering, anti-inflammatory treatments, and antithrombotic therapy.
Usage
Usage note: Distinguish from 'soft plaque' which refers to composition rather than rupture risk; maintain consistent terminology throughout imaging reports.
In Context
- "Optical coherence tomography identified a vulnerable plaque with thin-cap fibroatheroma characteristics in the proximal LAD." — interventional cardiology report
- "Intensive statin therapy aims to stabilize vulnerable plaque and reduce the risk of acute coronary events." — therapeutic strategy discussion