Physicians do not typically design treatment to specifically prevent a plaque rupture because it is very hard to measure the stability of plaque deposits. Instead, treatment for atherosclerosis focuses on reducing disease progression. This many include methods to reduce cholesterol, including exercise and dietary changes. In addition to eating a heart-healthy diet, the following general recommendations are offered:

Cholesterol lowering therapy is advised for patients who have other risk factors such as diabetes, hypertension, smoking and a family history of coronary artery disease. Statins have been proven to hold the progression of atherosclerosis and reduce the risk of heart attack in high risk patients. This is presumably due to an anti-inflammatory effect that results in plaque stabilization, in addition to an effect that lowers serum cholesterol.

Medications that may be prescribed for people with atherosclerosis include:

• Antiplatelets (e.g., aspirin or clopidogrel) inhibit the formation of blood clots by decreasing the ability of platelets (the body’s natural blood-clotters) to bind together. In the case of atherosclerosis, antiplatelets prevent a damaged vessel from becoming blocked due to excessive concentration of platelets. Recently, it has been observed that the beneficial effects of aspirin are diminished with the use of nonsteroidal anti-inflammatory drugs (e.g., ibuprofen). Studies have also shown that men and women react differently to aspirin therapy. It appears that aspirin is more effective in preventing heart attacks in men than women, and more effective in preventing stroke in women than men.
  
  
• Anticoagulants also help to minimize the formation of blood clots.

If lifestyle changes and medication are not helpful for people with atherosclerosis, then more invasive interventions may be necessary to prevent plaque rupture. For example, the physician may choose to do a cardiac catheterization. During this procedure, a thin tube (catheter) is inserted through a blood vessel in the body (usually the groin) and fed all the way to the heart. Once in place, the physician may choose to do a balloon angioplasty, which uses a balloon-tipped catheter to press plaque back against the artery walls, increasing the amount of room through which blood can pass through the vessel.

A variant of the balloon angioplasty is the laser angioplasty. This procedure uses a laser-tipped catheter to emit pulsing bursts of light, destroying the built-up plaque in the artery and allowing the flow of blood to resume through the newly widened blood vessel. Because of the effectiveness of balloon angioplasty, laser angioplasties are rarely performed today.

This procedure uses a laser-tipped catheter to emit pulsing bursts of light, destroying the built-up plaque in the artery and allowing the flow of blood to resume through the newly widened blood vessel.

Alternatively, the physician may choose to do an atherectomy, particularly if the plaque in the artery is particularly hardened (calcified). The procedure uses one of three catheters, all of which destroy plaque by cutting it away. Depending on the technique used, the residue is pulverized and allowed to flow harmlessly through the bloodstream, or removed as the catheter is withdrawn, or vacuumed through the catheter and out of the body during the procedure.

In conjunction with an angioplasty or atherectomy, the physician may also choose to perform stenting, in which a wire mesh metal tube called a stent is inserted into the area of a damaged artery. The stent acts as a scaffold, stretching and supporting the artery walls, and permitting blood to flow freely through the previously blocked vessel. Stents now utilized are coated with a drug that reduces the chances of restenosis (re-narrowing). These are called drug eluting stents.

In some cases of severe atherosclerosis in multiple coronary arteries, the patient may be recommended for bypass surgery. During this surgery, bypass grafts (e.g. blood vessels) are harvested from a patient’s body and sewed onto the coronary arteries, thus routing blood around the blockage. This form of open-heart surgery is highly effective in restoring blood flow to the heart muscle.

These techniques (which are considered revascularization) are reserved for patients in whom the atherosclerotic plaque has resulted in obstruction to the coronary arteries (greater than 70 percent stenosis). This is particularly the case in the presence of symptoms or functional heart abnormalities due to such obstructions.

If the atherosclerosis occurs in the carotid arteries, the patient may be recommended for a surgery called carotid endarterectomy. During this procedure, the surgeon opens the arteries in the neck that supply the brain and face with oxygen-rich blood. The plaque deposits are stripped from the inside of the vessel, then the arteries are stitched shut. This can be a highly effective surgery to prevent stroke in some patients. Another approach is carotid angioplasty/stenting, as described above.