What is the difference between plaque fissure and coronary dissection ?

• 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.