Summary
New developments in invasive and noninvasive imaging have allowed detailed visualization of coronary pathology and have considerably increased our knowledge about plaque growth and rupture. Prospective natural history of atherosclerosis studies permitted evaluation of changes in plaque composition and assessment of the complexity of plaque evolution. Our inability to accurately predict which of the detected vulnerable plaques will rupture, when this will occur, and whether this event will have clinical implications cannot justify an invasive sealing of potential culprit lesions. However, this is likely to change in the future. The revolution occurring in invasive and noninvasive imaging and the advances in molecular biology are expected to provide additional information about atherosclerotic disease progression/regression, allow us to study this process in larger populations, and probably predict with a higher accuracy events and plaque ruptures. Although, few years ago, the early detection and invasive passivation of future culprit lesions appeared as an unrealistic dream, nowadays, it is regarded as a future potentiality.