- Plaque fissure is the most common intra-plaque event that precipitates an acute coronary syndrome.
- It is the site of attachment for coronary thrombus
- It can either be spontaneous or PCI induced.
- Plaque fissure can either be partial or complete and may reenter the lumen.
- Eccentric plaques are likely to fissure often , as the wall stress on the plaque shoulder region is high (Laplace law)
- Angiographically it is often difficult to differentiate fissure from true coronary dissection.Both manifest as intraluminal filling defect.Coronary dissection often extend beyond the length of plaque.
- Many of the reported cases of spontaneous coronary dissection are thought to be nothing , but plaque fissures and their extensions.
Is plaque fissure a painful event ?
Plaques do not have neural innervation.So the plaque fissure is generally not painful.But when it extends into the media of vessel wall it can be severely painful.
Dr.S.Venkatesan MD 
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