Invasive strategies to discriminate stable and unstable coronary plaques

Unstable coronary plaques with surface erosion and plaque rupture lead to acute coronary thrombosis, unstable angina pectoris and myocardial infarction. The in-vivo detection of plaque instability by angiography, intravascular ultrasound or angioscopy or by newly developed techniques, such as optical coherence tomography or by the observation of local temperature increases, offers the opportunity for deeper understanding of the mechanisms underlying plaque rupture and erosion. Pharmacological and transcatheter therapy might be directed more exclusively to unstable plaques, once more detailed knowledge about pathophysiological mechanisms as well as direct information about the individual plaque being treated is available.