ABSTRACT
Coronary artery disease (CAD) consistently remains the leading cause of death in the USA.1 Despite great advances in medical and revascularization therapies, CAD continues to exert enormous morbidity, mortality, and cost. Erosion or rupture of the vulnerable plaque is pivotal in the pathophysiology of acute coronary syndromes.2 Insights into the pathology and detection of the vulnerable plaque have been described elsewhere.3 Currently, medical therapy is the mainstay of treatment for the vulnerable plaque. The heavy burden of CAD that persists despite available therapy highlights the need for an alternative strategy, perhaps local or regional therapy. Among the local therapies proposed are balloon angioplasty, stents, local delivery of drugs, cryoplasty, sonotherapy, radiation, and photodynamic therapy. The focus of this chapter is the potential role of stents in vulnerable plaque management, including the rationale for stenting non-obstructive lesions, mechanical plaque stabilization, the benefits and risks of stenting, desirable stent designs, and proposed clinical trials to assess the utility of such therapy.
