• Macrophage pyroptosis, driven by NLRP3 inflammasome and caspase-1, is a critical driver of atherosclerotic plaque progression and instability.
• Targeting pyroptotic pathway components, such as gasdermin D and caspase-1, offers a promising therapeutic strategy for AS.
• Nanotechnology-based drug delivery systems enhance specificity and efficacy of pyroptosis modulators in atherosclerotic plaques.
• Modulating macrophage pyroptosis could reduce inflammation, stabilize plaques, and potentially reverse AS progression.