Plaque sealing: are the benefits outweighing the risks?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Imaging

Background:

• Chest pain with minor cardiac enzyme elevation and normal ECG can present diagnostic challenges.
• Non-obstructing coronary plaques with positive remodeling are increasingly recognized as potential sources of ischemic symptoms.

Observation:

• A 36-year-old male presented with acute chest pain, elevated troponin and CK-MB, but a normal ECG.
• 64-slice CT coronary angiography identified a large, non-obstructing, non-calcified plaque in the proximal LAD with positive vessel remodeling.
• Intravascular ultrasound confirmed CT findings, despite a normal conventional coronary angiogram.

Findings:

• A drug-eluting stent was successfully implanted to treat the identified plaque.
• Myocardial damage occurred during the stenting procedure.
• Six-month follow-up CT and angiography revealed minimal in-stent hyperplasia, indicating successful stent coverage and patency.

Implications:

• This case highlights the utility of advanced imaging like CT angiography and intravascular ultrasound in diagnosing non-obstructing coronary artery disease.
• It demonstrates the successful management of a symptomatic non-obstructing plaque with a drug-eluting stent.
• The findings underscore the importance of considering plaque characteristics beyond luminal stenosis in patients with atypical chest pain.