The thin-cap fibroatheroma: a type of vulnerable plaque - The major precursor lesion to acute coronary syndromes

While the concept of plaque 'vulnerability' implies a propensity towards th rombosis, the term vulnerable was originally intended to provide a morpholo gic description consistent with plaques that are prone to rupture. It is no w known that the etiology of coronary thrombi is diverse and can arise from entities of plaque erosion or calcified nodules. These findings have promp ted the search for more definitive terminology to describe precursor lesion s associated with rupture, now referred to as thin-cap fibroatheromas. This review focuses on the thin-cap fibroatheroma, as a specific cause of acute coronary syndromes. To put these issues into current perspective, we need to revisit some of the older literature describing plaque morphology in sta ble and unstable angina, acute myocardial infarction, and sudden coronary d eath. The morphology, frequency, and precise location of these thin-cap fib roatheromas are further discussed in detail. Potential mechanisms of fibrou s cap thinning are also addressed, in particular emerging data, which sugge sts the role of cell death "apoptosis" in cap atrophy. (C) 2001 Lippincott Williams & Wilkins, Inc.