Visualization of Vulnerable Coronary Plaque and Prevention of Plaque Rupture

• Published in: Juntendo Iji Zasshi = Juntendo Medical Journal Vol. 70; no. 4; pp. 260 - 268
• Main Authors: FUKASE, TATSUYA, DOHI, TOMOTAKA
• Format: Journal Article
• Language: English
• Published: Japan The Juntendo Medical Society 2024
• Subjects: intravascular ultrasound; near-infrared spectroscopy; plaque rupture; plaque sealing; vulnerable plaques; plaque rupture; intravascular ultrasound; near-infrared spectroscopy; plaque sealing; vulnerable plaques
• ISSN: 2187-9737; 2188-2126; 2188-2126
• DOI: 10.14789/jmj.JMJ24-0011-R

In daily clinical practice, assessing anatomical findings and the presence or absence of ischemia is pivotal for determining the need for percutaneous coronary intervention. However, concurrently, comprehending vulnerability can greatly assist in predicting future cardiovascular events and formulating preventive strategies for individual patients. This review aims to describe the vulnerability of coronary artery plaques, primarily focusing on vulnerable plaques through pathological, morphological, and physiological viewpoints. Our review emphasizes the usefulness of coronary imaging modalities for the diagnosis of vulnerable plaques and the assessment of their rupture risk, as well as the possibility of percutaneous coronary intervention as a management strategy for plaque stabilization. Our findings show that there have been sporadic accounts of the potential of preventing cardiovascular events through early invasive treatments in patients with moderate or greater ischemia and utilizing new-generation stents to seal lipid core plaques. Thus, it is anticipated that direct intervention targeting coronary plaques, coupled with strict low-density lipoprotein-cholesterol lowering therapy, can play a vital role in suppressing future cardiovascular events and archiving zero perioperative myocardial infarction.