Intravascular molecular imaging: translating pathophysiology of atherosclerosis into human disease conditions.

The article focuses on advances in intravascular molecular imaging modalities for detecting high-risk atherosclerotic plaques in coronary artery disease (CAD). It reviews current morphological imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), highlighting their limitations in characterizing molecular plaque features linked to vulnerability. Emerging hybrid imaging approaches—including near-infrared spectroscopy (NIRS), near-infrared fluorescence (NIRF), intravascular photoacoustic imaging (IVPA), and fluorescence lifetime imaging (FLIm)—offer enhanced molecular and biological insights by targeting lipid content, inflammation, protease activity, and calcification within plaques. The article emphasizes that combining morphological and molecular imaging may improve identification of vulnerable plaques and patient risk stratification, potentially guiding personalized treatment, though further clinical validation and safety assessments of novel agents are needed before widespread adoption.