Intracoronary Imaging for the Management of Vulnerable Plaques

TL;DR

This review discusses how intracoronary imaging helps detect and manage dangerous coronary plaques that can cause heart attacks.

Contribution

The paper highlights the role of IVUS and OCT in identifying vulnerable plaques and guiding treatment strategies.

Findings

IVUS and OCT can identify thin-cap fibroatheromas and differentiate plaque rupture mechanisms.

Imaging-guided strategies can stabilize high-risk plaques and improve patient outcomes.

Future technologies like AI and hybrid imaging may enhance risk assessment and treatment personalization.

Abstract

Vulnerable coronary plaques are the primary substrate for acute coronary syndromes, representing a significant challenge in cardiovascular care. This review examines the pivotal role of intracoronary imaging, specifically intravascular ultrasound (IVUS) and optical coherence tomography (OCT), in the detection and management of these high-risk lesions. We detail the technical principles of these modalities and their unique capabilities in characterizing plaque morphology, from identifying thin-cap fibroatheromas (TCFA) to differentiating mechanisms of plaque rupture and erosion. The article further synthesizes evidence on how imaging-guided strategies—ranging from intensive medical therapy to emerging interventional approaches like preventive stenting—can stabilize vulnerable plaques and improve patient outcomes. Finally, we explore future directions, including the integration of artificial intelligence and hybrid imaging technologies, which promise to refine risk stratification and personalize the treatment of coronary artery disease.

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