Nuevas tendencias en la evaluación de la placa vulnerable mediante técnicas de cateterismo

La muerte subita y los sindromes coronarios agudos son, frecuentemente, manifestaciones iniciales de la cardiopatia isquemica. Estudios post mortem han indicado que la composicion de las placas ateromatosas es un factor determinante para la predisposicion de las lesiones coronarias a la rotura y el subsiguiente evento clinico. La mayor parte de estos eventos esta relacionada con la rotura de placas ateromatosas situadas en lesiones hemodinamicamente no significativas. La deteccion de estas placas no obstructivas, pero ricas en lipidos, podria tener un gran impacto en la prevencion del infarto y la muerte subita. Actualmente, hay diversas tecnicas intravasculares capaces de evaluar distintos determinantes de vulnerabilidad coronaria localmente, tales como el tamano del core lipidico, el grosor y la inflamacion de la capsula fibrosa y el remodelamiento positivo. Mediante la conduccion de estudios prospectivos, estas nuevas modalidades poseen el potencial para proveer in vivo informacion acerca de la fisiopatologia de la historia natural de la aterosclerosis coronaria.

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