case_images: PMC10475523_01
case_images: (A) Pre-percutaneous coronary angiogram (PCI) revealing severe stenosis of the left anterior descending coronary artery (yellow arrow). (B) Post-PCI coronary angiogram revealing significant reduction in stenosis of the culprit lesion (yellow arrow). (C-G) Follow-up coronary computed tomography scan at 1 year showed a small soft eccentric plaque with very mild positive remodeling and less than 20% luminal stenosis (yellow arrow; C, maximum intensity projection; D, stretched-curved planar reconstruction; E-G, cross-sections).
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case_images: PMC10475523_01_fcvm-10-1153891-g001.jpg
case_images: F1
case_images: Emergency coronary angiography revealed severe stenosis proximal to the left anterior descending artery (LAD) despite the intracoronary injection of nitroglycerin (Figure 1A), which was determined to be the culprit lesion. Post-PCI angiography demonstrated no stenosis, with a TIMI grade 3 flow (Figure 1B). As the patient's chest pain with stress and at dawn suggested the association of coronary vasospasm in the development of plaque erosion, calcium channel blockers (CCBs) were administered. A 1-year follow-up coronary computed tomography scan showed a small soft eccentric plaque with very mild positive remodeling and less than 20% luminal stenosis (Figures 1C-G), and the patient remained symptom-free (The timeline was summarized in Table 1).
case_images: Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) images of the culprit lesion from distal to proximal. The asterisk (*) marks the second diagonal branch as a landmark. (A-C) Pre-percutaneous coronary angiogram (PCI) OCT revealing the presence of healed plaque (white arrowhead). The partial accumulation of macrophages was also identified in the healed plaque (yellow arrowhead). Minimum lumen area was 0.87 mm2. (D-F) Pre-PCI IVUS image showing a high-intensity marginal irregular mass in the culprit site (yellow arrow), suggesting thrombus rather than lipid plaque or necrotic tissue. (G-I) OCT examination in the LAD after excimer laser coronary angioplasty showing significant thrombus reduction and a preserved lumen size. (J,K) Further lumen expansion was achieved with the addition of balloon dilatation, and the minimum lumen area expanded to 5.49 mm2.
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case_images: PMC10475523_01_fcvm-10-1153891-g002.jpg
case_images: F2
case_images: Paul, MN, USA) revealed the presence of healed plaque (white arrowhead) with partial accumulation of macrophages (yellow arrowhead), and the minimum lumen area was 0.87 mm2 (Figures 2A-C). In contrast, IVUS (AltaViewTM; Terumo, Tokyo, Japan) confirmed high-intensity marginal irregular masses in the culprit site, suggesting thrombus formation by plaque erosion rather than lipid plaque or necrotic tissue (Figures 2D-F). OCT examination of the LAD after ELCA showed a significant reduction in plaque burden and preserved lumen size (Figures 2G-I). Final OCT images (Figures 2J-L) revealed favorable results, with the minimum lumen area expanding to 5.49 mm2.