Plaque Progression and Rupture in Obstructive Coronary Artery Disease: A Review of Current Imaging Modalities

imaging phenotypes. Thus, this study aimed to examine how intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), alongside coronary computed tomography angiography (CCTA), cardiac magnetic resonance (CMR), and positron emission tomography (PET), characterize these processes and enable longitudinal tracking of disease activity. Moreover, we briefly discuss emerging therapeutic implications of plaque imaging, focusing on how improved identification of vulnerable plaque features may inform risk stratification. Finally, we evaluate therapies that extend beyond lipid-lowering to modulate inflammatory and immune pathways, reinforce cap stability, and support a risk-adapted, trajectory-based pathway in which serial imaging and biomarkers guide treatment intensity. Together, these advances support a shift in clinical practice from stenosis-centered revascularization to imaging-guided, vulnerability-centered prevention.