Computed tomography for detection of vulnerable coronary plaque – A Cassandra's dream?

The majority of acute coronary syndromes occur without warning due to rupture of coronary atherosclerotic plaques. Coronary lesions prone to rupture reveal several high-risk features that can be identified before the development of devastating clinical events, using modern imaging modalities. Recent advances in coronary computed tomography angiography (CCTA) allow the identification, quantification, and risk stratification of coronary plaques. Unquestionably, attempts to identify high-risk plaques by CCTA provide a unique opportunity to implement targeted preventive measures and improve prognosis. This review highlights insights into the ability of CCTA for the identification of vulnerable plaque and prediction of future coronary events that might affect future diagnosis and management of coronary artery disease.