Vasa vasorum and vulnerable plaques

The role of vasa vasorum in atherosclerosis has been speculated upon for over a century,1-3 with interest waxing and waning but always overshadowed by the flood of literature about the many other factors known to play a role in atherogenesis. The recent development of more sophisticated imaging techniques such as microcomputed tomography (micro CT) in conjunction with molecular biology techniques (such as immunohistochemistry or Western blotting), however, offers the opportunity to analyze the vasa vasorum and their impact on the vascular vessel wall in more detail. Thus, recent research has led to convincing evidence that the abluminal part of the vessel wall, especially the adventitia and the vasa vasorum located there, may play as an important role in atherogenesis as the inner luminal layers of the vessel wall. In particular, vasa vasorum neovascularization in atherosclerosis has become one main focus of investigation within recent years because of its potential role in plaque development, growth, and progression from a stable to an unstable atherosclerotic lesion.