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Intravascular Molecular Imaging to Detect High-Risk Vulnerable Plaques: Current Knowledge and Future Perspectives

  • Intravascular Imaging (A Truesdell, Section Editor)
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Abstract

Purpose of Review

To describe vulnerable plaque pathobiology and summarize potential targets for molecular imaging with a focus on intravascular near-infrared fluorescence (NIRF) and its translatable applications.

Recent Findings

Structural imaging alone is unable to precisely identify high-risk plaques in patients with coronary artery disease (CAD). Intravascular near-infrared fluorescence (NIRF) imaging is an emerging translational approach that can image specific in vivo molecular processes and cells that characterize vulnerable plaques. High-priority NIRF targets imaged by intravascular NIRF imaging thus far include macrophages, cathepsin protease activity, oxidized low-density lipoprotein (oxLDL), and abnormal endothelial permeability. The newest generation of NIRF catheters is multimodal in nature and combines NIRF with either IVUS or OCT, providing simultaneous co-registered morphological and pathobiological assessment of atherosclerotic plaques. While most intravascular NIRF studies have been performed in a preclinical environment, a first-in-human NIR autofluorescence-OCT trial has recently been performed. These developments suggest that clinical intravascular NIRF molecular imaging will be available within the next 3 years.

Summary

Molecular imaging is a powerful approach to enhance our understanding of atherosclerosis pathophysiology. Intravascular NIRF/OCT and NIRF/IVUS molecular imaging is nearing its use in atherosclerosis patients and will initially leverage indocyanine green (ICG) as an FDA-approved NIRF agent that reports on abnormal plaque permeability. Clinical trials are needed to assess the value of intravascular NIRF imaging using ICG as well as other novel NIRF imaging agents to better understand vulnerable plaque pathobiology, event prediction, and to enable personalized pharmacotherapy of high-risk plaques and patients.

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Funding

This work was supported by NIH 1R01HL137913 (F.A.J.).

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Authors and Affiliations

  1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Haitham Khraishah

  2. Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Simches Research Building, Room 3206, Boston, MA, 02114, USA

    Haitham Khraishah & Farouc A. Jaffer

  3. Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Farouc A. Jaffer

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Correspondence to Farouc A. Jaffer.

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Dr. Khraishah has no conflict of interest to disclose. Dr. Jaffer has received sponsored research grants from Canon and Siemens; he is a consultant for Boston Scientific, Abbott Vascular, Siemens, Philips, and Acrostak. Massachusetts General Hospital has a patent licensing arrangement with Canon, and Dr. Jaffer has the right to receive royalties.

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Khraishah, H., Jaffer, F.A. Intravascular Molecular Imaging to Detect High-Risk Vulnerable Plaques: Current Knowledge and Future Perspectives. Curr Cardiovasc Imaging Rep 13, 8 (2020). https://doi.org/10.1007/s12410-020-9527-z

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