One specific comment that caught my attentions was that the authors start with the premise of identifying the presence of a “vulnerable plaque“. And then, in their discussion they mention that: “The predictive value of plaque hemorrhage and intra-plaque vessel density could enable early identification of the vulnerable patient…” This is the term commonly used by those in the school of thought that don’t believe in identifying the vulnerable plaques, but rather the vulnerable patient in order to intervene.

So, does finding a plaque with characteristics associated with vulnerability mean that we must deal with a vulnerable patient and forget about that specific single plaque?

Thoughts?

The concept is that certain plaque features e.g. in the carotid artery, are a systemic marker of future cardiovascular events.

Note that plaque hemorrhage, marked intraplaque vessel formation demonstrated an increased risk of primary outcome. However, macrophage infiltration, large lipid core, calcifications, collagen, and smooth muscle cell infiltration were not associated with clinical outcome.