Abstract:

Acute coronary syndromes (ACS) often results from the rupture or erosion of high-risk coronary atherosclerotic plaques (i.e., vulnerable plaques). Advances in intracoronary imaging such as intravascular ultrasound, optical coherence tomography, or near-infrared spectroscopy have improved the identification of vulnerable plaques, characterized by large plaque burden, small minimal luminal area, thin fibrous cap, and large lipid content. While pharmacology, including lipid-lowering agents, and intensive risk-factors control are pivotal for management of vulnerable plaques and secondary prevention, recurrent events tend to accrue despite intensive pharmacotherapy. Therefore, it has been hypothesized that local preventive percutaneous coronary intervention (PCI) may passivate these vulnerable plaques, preventing the occurrence of plaque-related ACS. However, solid evidence is lacking on its use for treatment of non-flow-limiting vulnerable plaques. As such, the optimal management of vulnerable plaques has not been established. Herein, we have reviewed the diagnosis and management of vulnerable plaques, focusing on systematic pharmacology and focal treatments.

JACC: Asia Editor-in-Chief 

Jian’an Wang, MD, PhD, FACC

CME Editor 

Kenneth A. Ellenbogen, MD

Author
Matthew Pierce, MD, MBA

Important Dates

Date of Release: June 4, 2024
Term of Approval/Date of CME/MOC Expiration: June 3, 2025