[Intravascular ultrasound-guided diagnosis after transmural anterior ischemia and cardiogenic shock]

Area of Science:

• Cardiology
• Interventional Cardiology
• Diagnostic Imaging

Background:

• Acute coronary syndrome (ACS) complicated by cardiogenic shock presents a significant mortality risk.
• Timely coronary angiography is crucial for guiding therapeutic decisions in ACS.
• Thrombolysis is a common treatment for ACS, but may not always reveal underlying pathology.

Observation:

• This report details a case of ACS where coronary angiography did not show high-grade stenosis after thrombolysis.
• Intravascular ultrasound (IVUS) examination was pivotal in identifying the cause of the patient's condition.
• A ruptured plaque in the left main stem was diagnosed using IVUS.

Findings:

• IVUS provided critical diagnostic information beyond conventional angiography in this ACS case.
• The findings highlight the utility of IVUS in diagnosing non-obstructive coronary artery disease complications.
• Ruptured plaque in the left main stem, even without high-grade stenosis, can precipitate severe ACS.

Implications:

• This case underscores the importance of considering advanced imaging like IVUS when clinical presentation is discordant with angiographic findings.
• Accurate diagnosis of plaque rupture, regardless of stenosis severity, is essential for appropriate management of ACS.
• Therapeutic strategies for ACS may need to be tailored based on IVUS-detected plaque characteristics.