Erupted coronary atheroma: insights from multi-modality imaging

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Atherosclerosis Research

Background:

• Coronary artery disease diagnosis relies on identifying vulnerable atherosclerotic plaques.
• Multi-slice computed tomography (MSCT) is used to assess plaque characteristics, including stenosis severity and composition.
• Understanding plaque rupture mechanisms is crucial for preventing adverse cardiovascular events.

Observation:

• A 58-year-old male presented with chest pain and ST-segment elevation, indicating acute coronary syndrome.
• MSCT suggested a vulnerable plaque with low density and positive remodeling.
• Intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) revealed a ruptured plaque lacking lipid material, contradicting MSCT findings.

Findings:

• Discrepancies between MSCT and IVUS/NIRS in plaque characterization were observed.
• The absence of detectable lipid material by IVUS/NIRS, despite MSCT indications, suggests lipid embolization post-rupture.
• A zero lipid core burden index was noted, potentially due to lipid redistribution.

Implications:

• Multi-modality imaging provides a comprehensive view of plaque rupture pathophysiology.
• This approach can improve the understanding of coronary atheroma eruption in vivo.
• Accurate plaque characterization is essential for guiding treatment strategies in complex coronary artery disease cases.