“New Paradigms in Angioplasty,” by Dr. Gregg Stone

While most studies on angioplasty in stable coronary artery disease have shown an improvement in angina frequency and exercise capacity, there is no significant reduction in death and acute myocardial infarction (AMI). Currently, one of the main factors is the definition of vulnerable plaque, because it is associated with increased cardiovascular events. 

One of the main precursors of plaque rupture is thin-cap fibroatheroma. This feature of atheroma plaque can be identified using intravascular imaging such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT). 

We now have several studies to identify at-risk atheroma plaques and be able to prevent future cardiovascular events. Dr. Stone mentioned in his lecture the findings of the PROSPECT Study where there was a correlation between plaque volume in the nonculprit vessel and cardiovascular events at follow-up. 

Then, Dr. Stone concluded that vulnerable plaques are not mild, but severe, and that we must stop relying on angiography as the only method to assess them. 

In his presentation, he left us with a very interesting question: should we look for and treat vulnerable plaque? Answering this question is a great challenge for cardiology. However, we know that we must use all possible tools to detect vulnerable plaque and optimize all clinical variables to prevent future cardiovascular events in our patients. 

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