Catheter-Induced vs Spontaneous Plaque Rupture in a Patient With Acute Coronary Syndrome

Plaque rupture at the left main coronary artery (LMCA) ostium is a clinically important lesion that requires accurate assessment and tailored intervention.

A 75 year-old woman with non-ST-segment elevation myocardial infarction underwent coronary angiography. Initial imaging suggested a catheter-induced dissection at the LMCA ostium. However, intravascular ultrasound (IVUS) revealed a lipid-rich plaque rupture. IVUS-guided percutaneous intervention was performed, with optimal expansion and apposition.

This case illustrates the critical role of IVUS in differentiating between dissection and plaque rupture. IVUS provided detailed plaque characterization and ensured appropriate stent deployment, highlighting its superiority over angiography alone in complex LMCA lesions.

IVUS is essential for diagnosing and managing complex LMCA lesions. Early use of IVUS can clarify ambiguous angiographic findings and guide appropriate strategy.