Identifying and Treating Vulnerable Atherosclerotic Plaques.

Area of Science:

• Cardiology
• Vascular Biology
• Medical Imaging

Background:

• Acute coronary syndromes often result from coronary thrombosis on disrupted or eroded atherosclerotic plaques.
• These vulnerable plaques, typically nonobstructive, are the primary cause of myocardial infarction and sudden cardiac death.
• Traditional cardiology focused on obstructive lesions, overlooking vulnerable plaques.

Purpose of the Study:

• To explore the identification and management of vulnerable, thrombus-prone plaques.
• To discuss novel preventive strategies targeting asymptomatic high-risk plaques.
• To review noninvasive and interventional approaches for managing these lesions.

Main Methods:

• Utilizing computed tomographic angiography (CTA) to identify vulnerable plaques.
• Employing intravascular imaging during invasive coronary angiography for plaque detection.
• Analyzing noninvasive techniques and systemic therapies for patient management.

Main Results:

• CTA and intravascular imaging can identify a majority of vulnerable plaques before symptom onset.
• These imaging modalities enable the detection of nonobstructive, yet high-risk, plaques.
• New preventive strategies can be developed based on early plaque identification.

Conclusions:

• Vulnerable plaque identification is crucial for preventing thrombotic events like myocardial infarction.
• Noninvasive and systemic therapies offer avenues for managing patients with these lesions.
• A novel interventional paradigm may emerge for treating thrombus-prone plaques.