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Comment on ‘Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial’, published in The Lancet, https://doi.org/10.1016/S0140-6736(24)00413-6.

Comment

The concept of vulnerable plaque stemmed primarily from initial research demonstrating the key role of plaque rupture and coronary thrombosis in precipitating myocardial infarction (MI) and sudden cardiac death.2 Thin-cap fibroatheroma (TCFA), a plaque with a large lipidic core covered by a thin fibrous cap, has been historically considered as the prototype of the vulnerable plaque.2 While stabilization of high-risk plaques with systemic therapies has been the primary research objective during the past few decades, recent studies have tested percutaneous strategies to seal isolated non-obstructive vulnerable plaques by implanting a stent [or a bioresorbable vascular scaffold (BVS)] to promote the formation of a protective cap of neointimal hyperplasia and pacify the underlying plaque, potentially preventing atherothrombosis.3 To constitute a viable target for preventive stenting, vulnerable plaques should be readily identifiable and have a strong association with hard outcomes (e.g. cardiac death or MI), but, most importantly, their prophylactic treatment should be safe, clinically meaningful (i.e. superior to currently available systemic therapies), and cost-effective. The PROSPECT ABSORB trial showed that percutaneous coronary intervention (PCI) with BVS of non-obstructive vulnerable plaques might safely increase lumen area and thicken the fibrous cap, but this study was not powered to assess clinical outcomes.4

Issue Section:
CardioPulse > Weekly Journal Scan
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