Targeted Theranostic Strategy for Atherosclerotic Plaques Using Intravascular Multimodal Imaging Techniques

Atherosclerosis, a chronic inflammatory disease, is a leading cause of fatal cardiovascular events including myocardial infarction and stroke, primarily due to plaque rupture. The development of plaques is largely driven by the accumulation of macrophages and lipids within the arterial walls, which are central to the progression of atherosclerotic lesions and have emerged as potential therapeutic targets. However, current therapies cannot accurately target and resolve high-risk inflamed plaques, often leading to off-target damage to healthy vascular cells and increasing complications, such as thrombosis. Additionally, most theranostic strategies, which integrate both diagnostic and therapeutic capabilities, have primarily demonstrated efficacy in murine models, limiting their direct application to human coronary arteries. Recent advancements in targeted drug delivery and photoactivation strategies, combined with customized intravascular structural-molecular imaging, have shown significant promise in overcoming these challenges. Multimodal imaging techniques, such as optical coherence tomography (OCT) and near-infrared fluorescence (NIRF), enable real-time visualization and the precise treatment of plaque inflammation. OCT offers high-resolution imaging of plaque structures, while NIRF detects inflammatory activity, enabling accurate localization of macrophage- and lipid-rich plaques. Following targeted delivery and uptake by plaque macrophages, these theranostic strategies can rapidly resolve plaque inflammation and promote stabilization through orchestrated therapeutic interactions. Accordingly, these clinically relevant theranostic strategies could offer a promising path toward personalized, imaging-guided therapies for human cardiovascular disease, potentially revolutionizing the diagnosis and treatment of atherosclerosis.