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Coronary atherosclerosis with acute thrombosis is the most common cause of sudden cardiac death. Because the disruption of coronary atherosclerotic plaques triggers acute thrombosis, it is important to identify disruptionprone plaques with imaging modalities. The pathology of “plaque disruption” incudes three distinct morphologic entities: plaque rupture, plaque erosion, and calcified nodule. Currently, invasive imaging modalities such as intravascular ultrasound and intravascular optical coherence tomography can identify rupture-prone plaques, or thin-cap fibroatheromas, and calcified nodules, and unveiled that asymptomatic, multiple-plaque ruptures are a frequent complication in patients with coronary atherothrombosis. However, they cannot identify erosion-prone plaques. This article describes the morphological characteristics of coronary plaque disruptions and their possible mechanisms. In addition, the plaque imaging by nuclear medicine is discussed from a pathological viewpoint.

Pathology of Coronary Atherosclerotic Plaques and Mechanisms of Plaque Disruption