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Davide Capodanno/LinkedIn

Jan 16, 2026, 05:00

Plaque Rupture and Thrombosis

Davide Capodanno, Full Professor of Cardiology at the University of Catania, shared on X:

“Plaque rupture with thrombosis drives ACS, and thin-cap fibroatheroma is the archetypal high-risk plaque. There are consistent features of vulnerability across imaging modalities (large plaque burden, small MLA, TCFA, high LCBI, positive remodelling, etc.), with risk increasing when multiple features coexist. Yet absolute event rates remain low, consistent with pathology data showing most plaque ruptures are clinically silent.

So should we prophylactically stent high-risk plaques? According to this Viewpoint, completed trials (PROSPECT ABSORB, PREVENT) suggest no durable reduction in death or MI versus optimal medical therapy—benefits are limited to fewer revascularisations, at the cost of many unnecessary PCIs. With modern medical therapy, a wait-and-see strategy appears safe, avoiding most interventions without adverse consequences. For now, data favor surveillance and aggressive medical therapy over preventive PCI.

READ THE VIEWPOINT HERE.

thrombosis