Despite important clinical advances in the prevention and treatment of atherosclerosis during the past 20 years, atherosclerotic disease remains the first cause of mortality in industrialized countries. 1,2 Atherosclerosis is a complex disease where cholesterol deposition, inflammation, and plaque formation play a major role. Although the causes of atherosclerosis are not completely understood, most atherosclerotic lesions are characterized by a thickening of the arterial intima and are typically composed of a lipid core and an overlying fibrous cap. 3–6 X-ray angiography remains the gold standard for diagnosis and quantification of atherosclerotic plaques. X-ray angiography is an invasive technique that is used to visualize flow-limiting arterial stenoses, allowing for an indirect measure of atherosclerotic burden. Positive remodeling of the arterial wall — a process in which the vessel dilates to limit the narrowing of the lumen in the presence of atherosclerotic plaques — leads to an underestimation of the true extension of atherosclerosis disease with x-ray angiography.