This podcast examines the unique biological resilience of the internal mammary artery (IMA), which remains remarkably resistant to atherosclerosis despite being exposed to the same systemic risks as other vessels. While traditional risk factors drive disease in most arteries, the IMA possesses specialized endothelial properties, including high nitric oxide production and a robust internal elastic lamina, that prevent plaque buildup. Its anatomical structure promotes stable anterograde blood flow, fostering an anti-inflammatory environment that preserves vascular health even during the aging process. Because of these protective qualities, the IMA is the preferred conduit for bypass surgery, demonstrating superior long-term survival rates compared to vein grafts. By shifting the medical focus from systemic risks to these localized mechanisms of resistance, researchers hope to discover novel therapeutic targets to treat cardiovascular disease. The text emphasizes that understanding why this specific artery "bounces back" from injury could revolutionize how we address unmet medical needs in heart health.

This podcast is based on the excellent article " Resilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet Needs" by Kraler et al. published in Journal Arteriosclerosis, Thrombosis, and Vascular Biology

Arterioscler Thromb Vasc Biol. 2021;41:2237–2251. DOI: 10.1161/ATVBAHA.121.316256

Welcome to Cardio Deep Dive latest episode. In today’s episode we focus on vulnerable plaque: the high-risk atherosclerotic lesion characterized by a thin fibrous cap, large lipid core and intense inflammation that predisposes to rupture, thrombosis, and acute coronary syndromes despite often minimal stenosis. We’ll explore its pathophysiology, clinical significance, and evolving imaging and management strategies to better prevent sudden cardiac events.

Drug Coated Balloons have emerged as a novel strategy in the treatment of coronary artery disease. However there are lots of challenges and myths surrounding their use.