Identifying and Treating Vulnerable Atherosclerotic Plaques

Acute coronary syndromes and, in particular, ST-elevation myocardial infarction are usu-ally caused by coronary thrombosis in which the thrombus develops either on a disrupted plaque (usually a thin-capped fibroatheroma) or an eroded atherosclerotic plaque. These thrombus-prone plaques are vulnerable or high-risk. Although, traditionally, cardiologists have concentrated on treating significant coronary obstruction, there has been great inter-est over the last 2 decades in possibly preventing the thrombotic causes of myocardial infarction/sudden coronary death by mostly identifying and stabilizing these asymptom-atic vulnerable or high-risk plaques, which, at least on invasive angiography, are mostly nonobstructive. Computed tomographic angiography and intravascular imaging during invasive coronary angiography have now been shown to identify a majority of these vul-nerable or high-risk plaques before symptoms, thus opening up new preventive strategies. In conclusion, this article discusses the identification and management of these thrombus-prone lesions and patients with these lesions either with noninvasive techniques and sys-temic therapies or possibly through a new and bold interventional paradigm. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;205:214-222)