PCCT and IVUS-NIRS for High-Risk Plaque Management
Chinh Duc Nguyen1, Dinh Cong Pham1, Huong Thi Quynh Tran1
1Cardiology Department, Can Tho Stroke International Services General Hospital, Can Tho, Vietnam.
Background:
High-risk coronary plaque may be underrecognized in patients with atypical symptoms and negative biomarkers. Advanced coronary imaging can add anatomical and prognostic information.
Case Summary:
A 59-year-old woman presented with acute chest pain, mild ischemic electrocardiographic changes, and negative high-sensitivity troponin. Photon-counting computed tomography (PCCT) showed a predominantly noncalcified, lipid-rich-appearing plaque in the left anterior descending artery despite a low risk profile. Angiography confirmed significant stenosis, and intravascular ultrasound with near-infrared spectroscopy (NIRS) demonstrated a high-risk plaque phenotype with maximum lipid core burden index over 4 mm of 347. Percutaneous coronary intervention used distal drug-coated balloon treatment and proximal-to-mid drug-eluting stent implantation. Postprocedural imaging confirmed adequate stent expansion and lower NIRS lipid signal.
Discussion:
This case highlights the complementary role of PCCT and intravascular imaging for identifying and managing vulnerable coronary plaque.
Take-Home Message:
PCCT for noninvasive plaque characterization and intravascular ultrasound-NIRS for intraprocedural guidance provide a complementary strategy for personalized management of vulnerable coronary plaque.
Related Concept Videos
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
Peripheral Artery Disease III: Interprofessional Care
Coronary Artery Disease V: Interprofessional Care
Atherosclerosis III: Management
Cardiac Catheterization IV: Nursing Management
Imaging Studies for Cardiovascular System V: CT
