In the Search of the Vulnerable Plaque: Current Diagnostic Techniques and Future Directions

Atherosclerosis and its consequences are the most rapidly growing vascular pathology in both developing and developed countries. However, most atherosclerotic plaques will remain harmless and only vulnerable plaques (a minority) have the potential of causing myocardial infarction. Disruption of the vulnerable plaque or plaque erosion and subsequent thrombosis is the most common pathophysiological mechanism leading to an acute coronary syndrome. Given the clinical importance of coronary plaque rupture and its consequences, a growing interest exists in the development and improvement of diagnostic modalities that will promptly and most importantly accurately detect and characterize the high-risk atheromatous plaque. These techniques may help risk stratification and allow the selection of the most appropriate therapeutic approaches. Current available techniques can be separated into invasive and non-invasive, the former providing more accurate information at this point of time, but non-invasive techniques are quite promising but require future follow up studies.