[Angioscopic diagnosis of ACS]

Culprit lesions of acute coronary syndrome can be detected by angioscopy as the disrupted yellow plaques. Angioscopy is a very sensitive diagnostic tool that can detect thrombus in human coronary arteries, and can identify the disrupted plaques as those with thrombus on them. Those culprit plaques may have a high risk of thrombotic occlusion; and stenting may be beneficial for those lesions. Therefore, identifying the real site of culprit lesions is important but difficult without angioscopy. Furthermore, it is important to clarify if stenting at the disrupted yellow plaques identified in the asymptomatic patients is beneficial or not. The detection of myocardial ischemia is an established indication for stenting, but the detection of thrombotic culprit lesion may be another indication.