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Vasospasm-Associated Plaque Erosion: A Case Report With Pathological Confirmation by Directional Coronary Atherectomy
Teruo Sekimoto1, Hiroaki Tsujita1, Yuki Numajiri2
1Division of Cardiology, Department of Medicine, Showa Medical University, Tokyo, Japan.
Background:
Plaque erosion is a significant cause of acute coronary syndromes, representing a distinct pathophysiological entity from plaque rupture. Coronary vasospasm is a suspected trigger for erosion, though its precise mechanisms are not fully understood. Furthermore, reports of its histopathological confirmation by directional coronary atherectomy (DCA) are limited.
Case Presentation:
We present the case of a 56-year-old male with organic coronary stenosis and a clinical history suggestive of vasospasm. Intravascular optical coherence tomography revealed features highly suggestive of plaque erosion, including an overlying white thrombus. To obtain a definitive diagnosis, DCA was performed for tissue acquisition. Subsequent histopathological examination of the retrieved specimens clearly confirmed plaque erosion, demonstrating a thrombus adherent to an intact, smooth muscle cell-rich intimal layer without disruption of a fibrous cap.
Conclusions:
This case provides DCA-confirmed pathological evidence for the clinically important potential link between coronary vasospasm and plaque erosion.
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