Plaque rupture is the most common cause of acute coronary syndromes and sudden cardiac death. Characteristics and pathobiology of vulnerable plaques prone to plaque rupture have been studied extensively over 2 decades in humans using optical coherence tomography (OCT), an intravascular imaging technique with micron scale resolution. OCT studies have identified key features of plaque vulnerability and described the in vivo characteristics and spatial distribution of thin cap fibroatheromas as major precursors to plaque rupture. In addition, OCT data supports the evolving understanding of coronary heart disease as a panvascular process associated with inflammation. In the setting of high atherosclerotic burden, plaque ruptures often occur at multiple sites in the coronary arteries, and plaque progression and healing are dynamic processes modulated by systemic risk factors. This review details major investigations with intravascular OCT into the biology and clinical implications of plaque vulnerability and plaque rupture.

斑块破裂是急性冠脉综合征和心源性猝死的最常见原因。过去 20 年来，人们使用光学相干断层扫描 (OCT)（一种具有微米级分辨率的血管内成像技术）对易于发生斑块破裂的易损斑块的特征和病理生物学进行了广泛研究。OCT 研究已经确定了斑块易损性的关键特征，并描述了薄帽纤维粥样斑块的体内特征和空间分布作为斑块破裂的主要前兆。此外，OCT 数据支持对冠心病作为与炎症相关的全血管过程的不断理解。在高动脉粥样硬化负荷的情况下，斑块破裂通常发生在冠状动脉的多个部位，斑块进展和愈合是由系统性风险因素调节的动态过程。这篇综述详细介绍了血管内 OCT 对斑块易损性和斑块破裂的生物学和临床意义的主要研究。