show that in 2012, 31% of all deaths were caused by cardiovascular disease, from which 7.4 million were due to coronary heart disease. 2 Acute coronary syndromes (ACS)are among the most severe complications of atherosclerosis, and the majority, although not all, take place due to atheromatous plaque rupture and subsequent thrombosis.3
Vulnerable atheromatous plaquesThe genesis of the atheroma is triggered by the appearance of a discontinuity in the endothelial layer, followed by an array of complex mechanical, biochemical, and biological mechanisms that will eventually lead to plaque formation. [4][5][6] The formed atherosclerotic plaque will undergo several pathophysiological changes, including the excessive accumulation of oxidized LDL-cholesterol, enhanced local inflammation, smooth muscle cell proliferation, and extracellular matrix degradation, which will eventually lead to its progression and destabilization. This paper presents the main characteristics of plaque vulnerability, the role of CCTA in the assessment of vulnerable plaques, and automatic segmentation techniques of the coronary artery tree based on CT angiography images. A detailed inventory of existing methods is given, representing the state-of-the-art of computational methods applied in vascular system segmentation, focusing on the current applications in acute coronary syndromes.