Introduction

The Centers for Medicare & Medicaid Services (CMS) requested from the Agency for Healthcare Research and Quality a brief review of the diagnosis and treatment of vulnerable plaque (VP) of coronary and carotid arteries. The Tufts-New England Medical Center Evidence-based Practice Center was asked to conduct this review. The aims of this report were to:

1. Review the concept(s) of VP.
2. Review any literature and/or statements from experts about the natural history of VP.
3. Review the various methods that have been suggested or actually used to diagnose this condition.
4. Review any information that may be available regarding the conceptual framework, which would inform the evaluation of such diagnostic techniques (e.g., what reference standard would be used in determining the accuracy of a proposed test?).
5. Review any literature and/or statements from experts about how VP, once identified, would be treated.
6. Review how the existence of methods for identifying VP may change the types of treatments or the types of patients who get treatment for carotid or coronary artery occlusions.

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