Vulnerable Plaque represents a high-risk atherosclerotic lesion prone to rupture, thrombosis and acute coronary syndromes. As understanding of plaque biology deepens, clinicians increasingly seek structured updates on Vulnerable Plaque when attending coronary-imaging and prevention tracks at a cardiology conference. With rapid evolution in imaging, risk-prediction algorithms and interventional technologies, this session provides an in-depth review of atherosclerotic-plaque risk stratification, a crucial component of modern cardiovascular prevention and intervention.

The session explores the cellular and molecular characteristics of vulnerable plaques, including thin fibrous caps, large lipid cores, macrophage infiltration, neovascularisation, microcalcifications and inflammatory activation. Participants learn how systemic risk factors—diabetes, dyslipidemia, hypertension, smoking and chronic inflammation—accelerate plaque destabilisation. Comparative analysis of plaque phenotypes across different vascular beds further illustrates the complexity of risk assessment.

Diagnostic emphasis is placed on high-resolution modalities such as OCT, IVUS, CT angiography and near-infrared spectroscopy. Attendees examine imaging features associated with high-risk lesions, including fibrous-cap thickness, lipid-core burden, plaque-erosion patterns, calcified nodules and biomechanical stress zones. Biomarkers, genetic markers and integrated risk-score models are also reviewed.

Management strategies focus on aggressive lipid-lowering therapy, antiplatelet optimisation, inflammation-modulating agents and targeted revascularisation. Discussions include the role of PCSK9 inhibitors, statins, dual-pathway inhibition, lifestyle transitions and emerging anti-inflammatory agents. Procedural considerations include identifying when preventive PCI or plaque-modifying techniques may benefit selected patients.

Future directions highlight AI-supported plaque-risk prediction, multi-omic profiling, cellular-targeted therapies, bioresorbable technology and imaging-integrated intervention planning. Participants gain a forward-looking perspective on personalised prevention and precise coronary intervention.