Atherosclerotic plaque results from a complex interplay between lipid deposition, inflammatory changes, cell migration and arterial wall injury. Over the past two decades, clinical trials utilizing invasive arterial imaging modalities, such as intravascular ultrasonography, have shown that reducing levels of atherogenic lipoproteins, mainly serum LDL-cholesterol (LDL-C), to very low levels can safely reduce overall atherosclerotic plaque burden and favourably modify plaque composition. Classically, this outcome has been achieved with intensive statin therapy. Since 2016, newer and potent lipid-lowering strategies, such as proprotein convertase subtilisin–kexin type 9 inhibition, have shown incremental effects on plaque regression and risk of clinical events. Despite maximal reduction in plasma LDL-C levels, considerable residual cardiovascular risk remains in some patients. Therefore, there is a need to study therapeutic approaches that address residual risk beyond LDL-C reduction to promote plaque stabilization or regression. Contemporary imaging modalities, such as coronary computed tomography angiography, enable non-invasive assessment of the overall atherosclerotic plaque burden as well as of certain local plaque characteristics. This technology could allow further study of plaque stabilization and regression using novel therapeutic approaches. Non-invasive plaque assessment might also offer the potential to guide personalized management strategies if validated for this purpose.

动脉粥样硬化斑块是脂质沉积、炎症变化、细胞迁移和动脉壁损伤之间复杂相互作用的结果。在过去的二十年中，利用侵入性动脉成像方式（例如血管内超声检查）的临床试验表明，将致动脉粥样硬化脂蛋白（主要是血清低密度脂蛋白胆固醇（LDL-C））水平降低到非常低的水平可以安全地减少总体动脉粥样硬化斑块负担并有利地改变牙菌斑组成。传统上，这种结果是通过强化他汀类药物治疗来实现的。自 2016 年以来，更新且有效的降脂策略，例如前蛋白转化酶枯草杆菌蛋白酶-kexin 9 型抑制，已显示出对斑块消退和临床事件风险的渐进影响。尽管血浆低密度脂蛋白胆固醇水平最大程度降低，但一些患者仍然存在相当大的残余心血管风险。因此，有必要研究治疗方法，解决除 LDL-C 降低之外的残余风险，以促进斑块稳定或消退。现代成像方式，例如冠状动脉计算机断层扫描血管造影，可以对总体动脉粥样硬化斑块负荷以及某些局部斑块特征进行非侵入性评估。这项技术可以使用新的治疗方法进一步研究斑块的稳定和消退。如果为此目的进行验证，非侵入性斑块评估还可能提供指导个性化管理策略的潜力。