Heart Podcast Identification and management of non-obstructive high-risk coronary artery plaque
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Feb 24, 2026 Craig Balmforth, PhD candidate and cardiologist at the University of Edinburgh who studies PET molecular imaging of coronary plaque. He talks about detecting non-obstructive high-risk plaques, how CT and PET reveal active microcalcification, the limits of MRI, debates around preventative PCI, and using imaging to target emerging RNA and anti-inflammatory therapies.
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Heart Attacks Often Start From Nonobstructive Unstable Plaques
- Most acute coronary events often come from angiographically non-flow limiting but biologically unstable plaques.
- Craig Balmforth explains these plaques have high inflammation, thin fibrous caps, and can rupture before causing significant stenosis.
CT Reveals Plaque Composition Not Just Narrowing
- Coronary CT angiography can detect plaque burden and specific adverse features beyond stenosis.
- Craig Balmforth highlights low attenuation plaque, positive remodeling, spotty calcification and the napkin ring sign as validated high-risk CT findings.
PET Identifies Active Microcalcification Linked To Risk
- PET molecular imaging offers functional data on plaque biology that complements anatomical imaging.
- Balmforth describes 18F sodium fluoride uptake localizing to culprit plaques and predicting future myocardial infarction and sudden cardiac death.