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REVIEW article

Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1507892

What have we learnt from histology about the efficacy of coronary imaging modalities in assessing plaque composition?

Provisionally accepted
Nathan Angelo Lecaros Yap Nathan Angelo Lecaros Yap 1Zahid Khan Zahid Khan 2,3,4Xingwei He Xingwei He 5Jae-Geun Lee Jae-Geun Lee 5Soe Maung Soe Maung 1Kimberley R Morgan Kimberley R Morgan 5Tingquan Zhou Tingquan Zhou 5Helle Precht Helle Precht 6Patrick W Serruys Patrick W Serruys 7,8Hector M. Garcia-Garcia Hector M. Garcia-Garcia 9Yoshinobu Onuma Yoshinobu Onuma 8Sean Hynes Sean Hynes 10Sebastian Kelle Sebastian Kelle 11Anthony Mathur Anthony Mathur 2,5Andreas Baumbach Andreas Baumbach 2,5Christos Bourantas Christos Bourantas 2,5*
  • 1 William Harvey Clinical Research Centre, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
  • 2 Barts Heart Centre, London, England, United Kingdom
  • 3 University of South Wales, Treforest, United Kingdom
  • 4 University of Buckingham, Buckingham, United Kingdom
  • 5 William Harvey Heart Centre, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, United Kingdom
  • 6 Conrad Research Center, Radiography Education, University College Lillebaelt, Odense, Denmark
  • 7 Heart Science, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, England, United Kingdom
  • 8 Department of Cardiology, School of Medicine, University of Galway, Galway, County Galway, Ireland
  • 9 MedStar Washington Hospital Center, Washington D.C., District of Columbia, United States
  • 10 Department of Pathology, School of Medicine, University of Galway, Galway, County Galway, Ireland
  • 11 Department of Cardiology, Radiology and Intensive Care Medicine, Deutsches Herzzentrum Der Charite, Berlin, Germany

The final, formatted version of the article will be published soon.

    Accurate evaluation of coronary artery pathology is essential for risk stratification and tailoring appropriate treatment. Intravascular imaging was introduced for this purpose 40 years ago enabling for the first time in vivo plaque characterization. Since then, several studies have evaluated the efficacy of the existing intravascular imaging modalities in assessing plaque pathology and composition and their potential in guiding intervention and predicting vulnerable plaques. Today it is known that intravascular imaging is an indispensable tool in percutaneous coronary intervention planning, but the existing modalities have a limited efficacy in predicting lesion vulnerability; a fact that should be attributed to their advantages and limitations in accurately assessing morpho-pathological features that are common in advanced atherosclerotic plaques. This review aims to provide a comprehensive evaluation of the performance of intravascular imaging in characterizing plaque phenotypes using histology as a reference standard; it summarizes the studies comparing the available invasive imaging techniques against histology, discusses the findings and limitations of these studies and highlights the potential of novel intravascular imaging approaches that were introduced for a more complete and comprehensive evaluation of plaque pathobiology.

    Keywords: Intravascular ultrasound, Optical Coherence Tomography, near-infrared spectroscopy, Histology, Hybrid intravascular imaging

    Received: 08 Oct 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Yap, Khan, He, Lee, Maung, Morgan, Zhou, Precht, Serruys, Garcia-Garcia, Onuma, Hynes, Kelle, Mathur, Baumbach and Bourantas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Christos Bourantas, William Harvey Heart Centre, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, England, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.