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Ultrasound attenuated coronary plaque as a risk factor for slow flow or no-reflow during percutaneous coronary

Shinichi Furuichi1, Akira Itoh, Hatsue Ishibashi-Ueda

  • 1Department of Cardiology, Osaka City General Hospital, Miyakojima-hondori, Miyakojima-ku, Osaka.

Journal of Cardiology
|April 28, 2007
PubMed

Insights

Ultrasound-attenuated plaque during percutaneous coronary intervention (PCI) can predict no-reflow complications. This lipid-rich plaque may cause distal embolization, necessitating protective devices during PCI.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Slow flow or no-reflow is a significant complication during percutaneous coronary intervention (PCI).
  • Risk factors for no-reflow during PCI remain incompletely understood.
  • Stable angina necessitates coronary angiography and intervention.

Observation:

  • Intravascular ultrasound revealed an ultrasound-attenuated coronary plaque characterized by eccentricity and reduced echo backscatter.
  • The plaque lacked calcification but was bulky and eccentric in the left anterior descending artery.
  • Directional coronary atherectomy (DCA) was performed due to the lesion's characteristics.

Findings:

  • Serious no-reflow occurred immediately after DCA.
  • Analysis of the DCA specimen indicated lipid-laden atheromatous gruel.
  • This gruel likely attenuated ultrasound reflection and caused distal embolization, leading to no-reflow.

Implications:

  • Ultrasound-attenuated coronary plaque is identified as a predictor of no-reflow during PCI.
  • The findings suggest a need for enhanced distal protection strategies during interventions involving such plaques.
  • Further research into plaque characteristics and their association with PCI complications is warranted.

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