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Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality worldwide. Several cardiovascular risk factors are implicated in atherosclerotic plaque promotion and progression and are responsible for the clinical manifestations of coronary artery disease (CAD), ranging from chronic to acute coronary syndromes and sudden coronary death. The advent of intravascular imaging (IVI), including intravascular ultrasound, optical coherence tomography and near-infrared diffuse reflectance spectroscopy has significantly improved the comprehension of CAD pathophysiology and has strengthened the prognostic relevance of coronary plaque morphology assessment. Indeed, several atherosclerotic plaque phenotype and mechanisms of plaque destabilization have been recognized with different natural history and prognosis. Finally, IVI demonstrated benefits of secondary prevention therapies, such as lipid-lowering and anti-inflammatory agents. The purpose of this review is to shed light on the principles and properties of available IVI modalities along with their prognostic significance. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is the leading cause of disability and death in both women and men; considerable differences in clinical presentation, natural history and prognosis are reported between sexes. Different pathophysiological mechanisms play a major role, including sex-related and gender-related features or a combination of both. Reports from intracoronary imaging studies pointed towards morphological plaque features, which seemed to differ between men and women, albeit results reported so far were not conclusive. The purpose of this review is to shed light on differences in the pathophysiology underlying CAD in women vs men including the description of coronary plaque phenotype and mechanisms of plaque instability, as assessed by intracoronary imaging. We will also discuss potential clinical implications with the aim to move towards a sex and gender-based personalized approach in CAD patients. [Display omitted] • Women develop CAD later, as compared to men, and experience worse prognosis. • Sex- and gender-related features are implicated in differences in CAD between sexes. • Intracoronary imaging pointed out differences in plaque phenotype and mechanisms of plaque instability between sexes. • Biological and psychosocial characteristics lead to an accelerated atherosclerosis in women with aging. • A broader and targeted therapeutic approach is required in women with CAD. [ABSTRACT FROM AUTHOR]