摘要： Using intravascular imaging to identify the impact of statins on vulnerable plaques has a long and rich history. Intravascular ultrasound (IVUS) imaging of coronary arteries first provided a more comprehensive assessment of atherosclerotic plaques in vivo than coronary angiography. Subsequent advances in tissue characterization of gray-scale IVUS allowed observers to visually identify the composition of plaques as lipid cores, fibrous tissue, and even thick fibrous caps. Early IVUS trials demonstrated a slowing or halting of progression and even regression of atherosclerosis during statin treatment. The advent of three-dimensional (3D) IVUS image reconstructions allowed more precise characterization of a reduction in lipid volume and increases in fibrous volume as a result of high-dose statin therapy. Following the introduction of virtual histology-intravascular ultrasound (VH-IVUS), with its ability to detect various types of plaques in an automated fashion, statin therapy studies indicated a reduced external elastic membrane area and calcium volume but, surprisingly, decreased fibrous plaque volume and had no effect on necrotic core volume. An obvious question is why this meta-analysis of 9 VH-IVUS trials did not demonstrate the anticipated beneficial effects of statins. Furthermore, the major limitation with IVUS in those studies was the inability to identify changes in thin-cap fibroatheroma(s) (TCFA) thickness due to limited spatial resolution of approximately 100 mm. TCFAs are the lesions most likely to rupture and are strongly predictive of major adverse cardiovascular events.