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Cerebrovascular and Carotid Artery Diseases / Peripheral Artery Disease Management · Journal article
Indonesian Journal of Cardiology · July 15, 2026
A consensus or society position rather than new primary data.
This is an expert consensus position statement from the Indonesian Society of Interventional Cardiology on the detection and selective treatment of coronary vulnerable and high-risk plaque. The statement synthesizes advances in imaging, biomarkers, and pharmacotherapy, but cautions that preventive PCI remains investigational with unresolved questions around patient selection, durability, and cost-effectiveness, particularly in resource-limited settings.
Journal article. Patients with coronary vulnerable or high-risk plaque, with emphasis on applicability to resource-constrained healthcare systems and Indonesia. Indonesia, with reference to resource-constrained healthcare systems globally.
The concept of vulnerable plaque has evolved to encompass high-risk plaque phenotypes including rupture-prone, erosion-prone plaques, calcified nodules, and plaque burden Advances in CCTA, IVUS, OCT, NIRS, molecular imaging, and AI have substantially improved detection and characterization of high-risk plaque PREVENT trial has reignited interest in preventive PCI for non-flow-limiting vulnerable plaques, though important uncertainties remain regarding patient selection and long-term outcomes
Contemporary pharmacological therapy has improved natural history of coronary atherosclerosis through plaque stabilization and fibrous cap thickening
Clinicians should prioritize aggressive optimal medical therapy as the foundation of care. Advanced plaque imaging and preventive PCI should be considered only for carefully selected patients with converging high-risk features and high patient-level risk, particularly in resource-limited settings where cost-effectiveness and pragmatic implementation are essential.
This is a consensus position statement from the Indonesian Society of Interventional Cardiology synthesizing evidence on vulnerable plaque detection and selective preventive PCI, offering clinical recommendations rather than reporting original trial data.
As stated by the source record.
Clinicians should prioritize aggressive optimal medical therapy as the foundation of care. Advanced plaque imaging and preventive PCI should be considered only for carefully selected patients with converging high-risk features and high patient-level risk, particularly in resource-limited settings where cost-effectiveness and pragmatic implementation are essential.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
The concept of coronary vulnerable plaque has evolved from a histopathological concept into a potential therapeutic target for precision cardiovascular prevention. Recent evidence has expanded this paradigm beyond the traditional vulnerable-plaque construct towards the broader concept of high-risk plaque, encompassing rupture-prone plaques, erosion-prone plaques, calcified nodules, plaque burden, inflammatory activity, healing capacity, and patient-level susceptibility to thrombosis.Advances in Coronary Computed Tomography Angiography (CCTA), Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT), Near-Infrared Spectroscopy (NIRS), molecular imaging, and Artificial Intelligence (AI) have substantially improved the detection and characterization of high-risk plaque. Circulating lipid, inflammatory, metabolic, and renal biomarkers provide complementary information regarding patient vulnerability. Concurrently, contemporary pharmacological therapy has substantially improved the natural history of coronary atherosclerosis by promoting plaque stabilization, fibrous cap thickening, lipid core regression, and attenuation of vascular inflammation.The emergence of preventive Percutaneous Coronary Intervention (PCI) for non-flow-limiting vulnerable plaques, particularly following the PREVENT trial, has reignited interest in focal treatment before clinical destabilization. Nevertheless, important uncertainties remain regarding patient selection, diagnostic thresholds, imaging strategies, device selection, long-term durability, cost-effectiveness, and applicability in resource-limited healthcare systems. Drug-Eluting Stents (DES) remain the most established device platform, whereas next-generation bioresorbable scaffolds and Drug-Coated Balloons (DCB) may offer future approaches to local plaque treatment without permanent metallic implantation. Although Coronary Artery Bypass Grafting (CABG) does not directly treat vulnerable plaques, it may indirectly protect selected patients with diffuse multivessel disease by bypassing plaque-bearing coronary segments.For Indonesia and other resource-constrained healthcare systems, future implementation should emphasize pragmatic implementation rather than widespread adoption of advanced technologies. Emphasis should remain on aggressive Optimal Medical Therapy (OMT), selective use of advanced imaging, careful identification of patients at the highest absolute cardiovascular risk, structured operator training, national registries, and rigorous evaluation of cost-effectiveness. The ultimate objective is not simply to detect more vulnerable plaques but to prevent more myocardial infarctions and cardiovascular deaths through efficient use of healthcare resources.The Indonesian Society of Interventional Cardiology (ISIC) recommends that aggressive systemic prevention, centered on OMT, should remain the foundation of care. Advanced plaque imaging and preventive PCI should be reserved for carefully selected patients with converging high-risk plaque characteristics, high patient-level risk, and a favorable benefit–risk profile.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.