High-Resolution Intravascular Ultrasound: Advances in Coronary Plaque Characterization

Abstract

Abstract Purpose of Review This review assesses high-resolution intravascular ultrasound (HR-IVUS) in characterizing coronary vulnerable plaques and enhancing acute coronary syndrome (ACS) management, focusing on its clinical applications and emerging technologies for risk stratification and personalized treatment. Recent Findings HR-IVUS, with 20–50 μm resolution, outperforms conventional IVUS (70–150 μm), identifying thin-cap fibroatheromas (TCFAs) and high-risk features like lipid content. Multimodal imaging (IVUS-NIRS, IVUS-OCT) improves accuracy, while ultrahigh-frequency ultrasound (>100 MHz) achieves 14–24 μm resolution, though penetration is limited. Dual-element IVUS enhances stability, and AI boosts plaque classification (up to 92.6% accuracy). Studies (e.g., PROSPECT) link HR-IVUS features (plaque burden >70%) to a fivefold higher MACE risk. Challenges include cost and validation. Summary HR-IVUS advances ACS risk assessment with superior plaque detection. Innovations in imaging and AI enhance its utility, promising broader applications despite current limitations, potentially reducing ACS incidence and supporting precision cardiovascular care.