(Circulation. 2000;101:e114.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
Longitudinal Visualization of Spontaneous Coronary Plaque Rupture by 3D Intravascular Ultrasound
From the Second Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Correspondence to Takafumi Hiro, MD, PhD, The Second Department of Internal Medicine, Yamaguchi University School of Medicine, 1-1-1 MinamiKogushi, Ube, Yamaguchi, 755-8505, Japan. E-mail thiro{at}po.cc.yamaguchi-u.ac.jp
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Introduction |
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 Top Introduction |
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A 60-year-old man, 4 years after an anterior myocardial infarction at the middle segment of the left anterior descending coronary artery (LAD), underwent coronary angiography (CAG) because of severe continuous chest pain for >3 hours 3 weeks earlier. CAG revealed no significant stenosis but showed a wall fissure with a double-contrast opacification at the proximal segment of the LAD (short arrow on CAG in the Figure
), which had
not been detected by CAG 4 years earlier. This ulceration may have
developed at the time of chest pain, and any thrombus might have formed
at the lesion, then autolyzed. Two-dimensional intravascular ultrasound
(2D-IVUS) revealed a plaque ulceration in an eccentric plaque
(Figure, asterisk). The rupture occurred at the shoulder of the
plaque, which is considered to be present in patients with acute
coronary syndrome. Longitudinal reconstruction of the
consecutive IVUS images (L-IVUS), sequentially obtained by a
motorized pullback device from the proximal LAD, provided a spatial
representation of the plaque rupture. The rupture occurred at
the middle portion of the hypoechogenic plaque surface (asterisk) and
had a residual thin flap that probably corresponded to a thin fibrous
cap. Calcification was observed on the base of this plaque. Outlined
views of the plaque rupture are shown in the right panel of the
Figure for both 2D- and L-IVUS views. This L-IVUS image clearly
depicted the longitudinal ulceration of the plaque, as well as
which area in the surface of the plaque was vulnerable to rupture along
the vessel wall.
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Footnotes |
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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