Mechanisms of the vulnerable atherosclerotic plaque and imaging

Atherosclerotic disease is the leading cause of death worldwide. Plaque rupture and erosion lead to superimposed thrombosis and are responsible for the vast majority of acute ischaemic syndromes. Vulnerable plaques, plaques that are at increased risk of rupture, pose certain high-risk morphological features that can be imaged. Key processes include thin-cap fibroatheromas, larger plaque volume, larger lipid-rich necrotic core, neovascularization, intraplaque haemorrhage and spotty microcalcification. Various non-invasive and invasive imaging modalities have been developed with the aim to identify vulnerable plaque features in vivo and stratify patients at a higher risk of future cardiovascular events.