Table 3. Vulnerable Plaque Conundrum
What it originally meant
A plaque that is the culprit lesion for an acute coronary event
What it should mean
A plaque that is prone to rupture when all intrinsic and extrinsic effects are taken into account (regardless of structure)
How it is currently interpreted in the majority of literature
A plaque with specific morphological features—usually referring exclusively to thin cap fibroatheromas
  • This table attempts to summarize the different connotations inherent in the term “vulnerable plaque.” It can be appreciated that a teleological approach has shifted toward a utilitarian one, allowing for easier classification of plaques as “vulnerable” or not, yet depriving this characterization of prognostic implications.