Lingshan Liu, Zhen Wang, Liang Ma, Shengjun Wu
BACKGROUND: Atherosclerosis is a leading cause of cardiovascular disease. Recent advances in molecular biology have deepened our understanding of its pathogenesis and opened new avenues for surgical intervention. METHODS: This review integrates recent findings on key mechanisms-such as endoplasmic reticulum stress, oxidative imbalance, and immune-metabolic dysregulation-with progress in surgical and interventional strategies. RESULTS: Novel targets like UPR pathways, mitochondrial ROS, and microRNAs have shown therapeutic promise. RNA-based lipid-lowering therapies and PCSK9 inhibitors offer alternatives to statins. In parallel, innovations in PCI and CABG-such as next-generation stents, multi-arterial grafting, and engineered vascular conduits-have improved safety and efficacy. Advanced imaging techniques further enhance diagnosis and procedural planning. CONCLUSION: Integrating molecular insights with evolving surgical approaches is transforming atherosclerosis management. A precision strategy combining targeted therapy with individualized revascularization holds promise for better outcomes.