Prophylactic stenting of vulnerable plaques: pros and cons

Introduction

The majority of acute coronary syndromes (ACS) are caused by the rupture or erosion of coronary atherosclerotic plaques. In patients with myocardial infarction (MI), recurrent events tend to accrue despite the implementation of secondary prevention measures, which mainly consist of pharmacotherapy. During the last decade, advances in intravascular imaging (i.e., intravascular ultrasound [IVUS], optical coherence tomography [OCT], and near-infrared spectroscopy [NIRS]) led to the identification of morphological features that define “vulnerable plaques” and are linked to higher rates of cardiovascular events. It has been hypothesised that preventive stenting might passivate these lesions, preventing the occurrence of plaque-related acute coronary syndromes. However, stenting can be also associated with adverse outcomes, and no solid evidence is currently available on its use in this sort of “primary prevention” setting. As such, the optimal management of vulnerable plaques has not been established so far and is currently a matter of debate.

Pros

Duk-Woo Park, MD, PhD; Hoyun Kim, MD

Thrombosis of lipid-rich thin-capped atherosclerotic lesions (“vulnerable plaques” [VP]) is the cause of most ACS and unexpected sudden cardiac deaths1....