Atherosclerosis is a chronic systemic vascular disease known to start early in life. It progresses with age and other risk factors. When involving the coronary vessels, it may present gradually or acutely as anginal pain or as acute coronary syndrome. For decades this acute presentation has been studied. Certain plaque characteristics were identified to be the culprit for those acute coronary syndromes. Relentless efforts to increase the sensitivity of screening for these vulnerable plaques have been developed. The goal is to create a preemptive intervention strategy with effective medical or percutaneous therapies. In this article, we explore the different modalities for early identification and management of those vulnerable or high-risk plaques.

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