How can the vulnerable plaque be identified?

The precise identification of a vulnerable plaque may have substantial clinical impact since the absolute majority of sudden death cases are related to acute coronary syndromes. Advances in imaging techniques have allowed for the development of numerous invasive and noninvasive tools to investigate coronary atherosclerosis. Contemporary natural history studies of atherosclerosis added information on changes in the morphological and compositional plaque characteristics. The objective of understanding these temporal changes is to predict plaques that are prone to have future events, which will change the way we approach vulnerable plaque treatment and strengthen the concept of plaque passivation. This review article summarizes the current definitions on vulnerable plaque, the recent advances in the study of atherosclerosis, current evidence, and highlights our limitations in understanding plaque evolution and predicting plaque destabilization.