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Intravascular Ultrasound-Detected Layered Plaque Mimicking Spontaneous Coronary Artery Dissection

Hideaki Suwa1, Keisuke Yasumura1, Samin K Sharma1

  • 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 25, 2025
PubMed

Insights

Diagnosing unclear coronary artery lesions is difficult. Intravascular imaging, like intravascular ultrasound (IVUS), offers crucial insights, distinguishing layered plaques from spontaneous coronary artery dissection (SCAD) for better patient management.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Coronary angiography can be inconclusive for diagnosing ambiguous culprit lesions, especially with vessel overlap or tortuosity.
  • Accurate diagnosis is critical for appropriate management of coronary artery disease.

Observation:

  • A 55-year-old female presented with recurrent chest pain, with initial suspicion of spontaneous coronary artery dissection (SCAD).
  • Coronary angiography yielded inconclusive results for the culprit lesion.

Findings:

  • Intravascular ultrasound (IVUS) demonstrated distinct plaque layers with varying echogenicity and clear borders.
  • These IVUS findings were more indicative of a layered plaque than SCAD.

Implications:

  • Intravascular imaging, specifically IVUS, is valuable for characterizing ambiguous coronary lesions.
  • Accurate lesion characterization using IVUS aids in guiding appropriate therapeutic strategies and improving patient outcomes.

Keywords:
intravascular imaginglayered plaquespontaneous coronary artery dissection

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