Preventive Percutaneous Intervention of Vulnerable Coronary Plaques

Acute coronary syndromes and sudden cardiac death are frequently precipitated by the disruption and subsequent thrombotic occlusion of structurally vulnerable coronary plaques, most notably thin-cap fibroatheromas characterized by a large necrotic lipid core and a thin fibrous cap. A substantial proportion of these events arise from nonflow-limiting, hemodynamically insignificant lesions that are clinically silent prior to rapid destabilization. In addition to plaque rupture, thrombotic events may also result from superficial erosion or protruding calcified nodules. Conventional coronary angiography lacks the resolution and tissue characterization capability required to identify such high-risk morphological features, whereas advanced intravascular imaging modalities enable detailed plaque assessment. The detection of plaques with high-risk features has prompted investigation into prophylactic interventional strategies aimed at plaque stabilization. Emerging clinical data suggest that targeted treatment of vulnerable plaques may attenuate progression to acute coronary events. In conclusion, this review explores the evolving role of advanced imaging in identifying and potentially managing high-risk atherosclerotic lesions, with important implications for improving long-term cardiovascular outcomes.