Atherosclerotic Plaque Rupture: Identifying the Straw That Breaks the Camel?s Back

It is easy to see the breaking of the camel's back, as it is typically an obvious, final, and dramatic scene that catches everyone by surprise. Yet it is difficult to see the straw itself and to understand all the strain that silently builds up and contributes to the final event. Similarly, the rupture of unstable atherosclerotic plaques is a complex process ultimately representing a maladaptive response to hemodynamic conditions, lipid accumulation, arterial injury, necrosis, and inflammation. Growing understanding of the many facets of this pathological process offers multiple opportunities for early detection of unstable plaques with biomarkers and novel molecular imaging technologies, and hopefully will ultimately lead to the development of utterly needed plaque-stabilizing drugs.