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Progression of atherosclerotic plaque in coronary arteries is characterized by complex cellular and non-cellular molecular interactions. Within recent years, atherosclerosis has been recognized as inflammation-driven disease condition, where progressive stages are characterized by morphological changes in plaque composition but also relevant molecular processes resulting in increased plaque vulnerability. While existing intravascular imaging modalities are able to resolve key morphological features during plaque progression, they lack capability to characterize the molecular profile of advanced atherosclerotic plaque. Because hybrid imaging modalities may provide incremental information related to plaque biology, they are expected to provide synergistic effects in detecting high risk patients and lesions. The aim of this article is to review existing literature on intravascular molecular imaging approaches, and to provide clinically oriented proposals of their application. In addition, we assembled an overview of future developments in this field geared towards detection of patients at risk for cardiovascular events. [ABSTRACT FROM AUTHOR]

Progression of atherosclerotic plaque in coronary arteries is characterized by complex cellular and non-cellular molecular interactions. Within recent years, atherosclerosis has been recognized as inflammation-driven disease condition, where progressive stages are characterized by morphological changes in plaque composition but also relevant molecular processes resulting in increased plaque vulnerability. While existing intravascular imaging modalities are able to resolve key morphological features during plaque progression, they lack capability to characterize the molecular profile of advanced atherosclerotic plaque. Because hybrid imaging modalities may provide incremental information related to plaque biology, they are expected to provide synergistic effects in detecting high risk patients and lesions. The aim of this article is to review existing literature on intravascular molecular imaging approaches, and to provide clinically oriented proposals of their application. In addition, we assembled an overview of future developments in this field geared towards detection of patients at risk for cardiovascular events., Competing Interests: Conflict of interest: M.J. reports personal fees from Abbott, Orbus Neich, Astra Zeneca, Recor, Schockwave, grants and personal fees from Biotronik, Boston Scientific, Cardiac dimensions, Edwards Lifesciences and grant support from Infraredx outside the submitted work. MJ has received funding from the German Center for Cardiovascular Research: DZHK (FKZ 81Z0600502; FKZ 81X2600526) and from the Leducq Foundation (grant agreement number 18CVD02). F.J. has received sponsored research from Kowa, Boston Scientific, Mercator, Canon, Siemens, Teleflex, Heartflow and Shockwave and is a consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc, Philips, Biotronik, and IMDS. F.J. has an equity interest in Intravascular Imaging, Inc. and DurVena. Massachusetts General Hospital has a patent licensing arrangement with Terumo, Canon, and SpectraWAVE; F.J. (Terumo, Canon, SpectraWAVE) have the right to receive royalties. V.N. is a founder and equity owner of sThesis GmbH, iThera Medical GmbH, of Spear UG and of I3 Inc. The other authors report no conflict of interest., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)