Advanced lesions

Type IV, V, and VI lesions are characterized by the appearance of a fibrous cap separating the lipid/ necrotic core of the plaque from the lumen. Type IV and V lesions are distinguished by the transition of the fibrous cap from one consisting primarily of pro-teoglycan and smooth muscle cells into a thicker collagen-rich cap in the latter type. Type VI lesions (Fig. 1) are characterized by disruption of the plaque leading to fibrous cap rupture, intraplaque hemorrhage, and/or luminal thrombi. Type VII lesions are predominately calcified, and Type VIII lesions consist of thickened, reparative fibrous connective tissue with an absence of necrotic cores or calcifications [10]. Lesions Type IV thru VI are of considerable importance in imaging with the goal of identifying them prior to clinical events.

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