Advances in coronary imaging of atherosclerotic plaques

Atherosclerosis is a complex disease with multiple factors associated with its progression and complications.Fibroatheroma is a pathological entity which contains abundant lipid, and often, a thin fibrous cap that is the most common underlying cause of acute myocardial infarction. Based on pathological descriptions, we propose a new imaging-based nomenclature indicating high-risk plaque characteristics that can be identified with imaging. Additionally, we review the literature indicating in vivo plaque characterisation as well as outlining the natural history of plaques and, more importantly, its responses to systemic and local therapies. Intravascular imaging has positively impacted how we evaluate atherosclerosis, and it can provide guidance on the use of tailored therapies and the evaluation of their long-term follow-up effects.