Vasospasm-Associated Plaque Erosion: A Case Report With Pathological Confirmation by Directional Coronary Atherectomy

Area of Science:

• Cardiology
• Pathology

Background:

• Plaque erosion is a key cause of acute coronary syndromes, distinct from plaque rupture.
• Coronary vasospasm is a suspected, yet poorly understood, trigger for plaque erosion.
• Histopathological confirmation of plaque erosion via directional coronary atherectomy (DCA) is infrequently reported.

Purpose of the Study:

• To present a case with definitive histopathological evidence of plaque erosion.
• To investigate the potential role of coronary vasospasm in plaque erosion.
• To highlight the utility of DCA in diagnosing plaque erosion.

Main Methods:

• A 56-year-old male with coronary stenosis and suspected vasospasm underwent evaluation.
• Intravascular optical coherence tomography (OCT) suggested plaque erosion with overlying thrombus.
• Directional coronary atherectomy (DCA) was performed for tissue acquisition and histopathological analysis.

Main Results:

• Histopathology confirmed plaque erosion, showing a thrombus on an intact, smooth muscle cell-rich intimal layer.
• No fibrous cap disruption was observed, differentiating it from plaque rupture.
• The findings provide direct pathological evidence supporting the diagnosis.

Conclusions:

• This case offers DCA-confirmed pathological evidence linking coronary vasospasm to plaque erosion.
• It underscores the importance of considering vasospasm in the pathophysiology of acute coronary syndromes.
• DCA serves as a valuable tool for definitive diagnosis of plaque erosion.