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(Circulation. 2003;108:e131.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Multiple Ruptured Plaques

Serial Intravascular Ultrasound Examinations

Nakabumi Kuroda, MD; Yoshio Kobayashi, MD; Gary S. Mintz, MD; Issei Komuro, MD

From the Department of Internal Medicine (N.K.), Sawara Hospital, Chiba, Japan; Cardiovascular Research Foundation (Y.K., G.S.M.), Lenox Hill Heart and Vascular Institute, New York, NY; and Department of Cardiovascular Science and Medicine (I.K.), Chiba University Graduate School of Medicine, Chiba, Japan.

Correspondence to Yoshio Kobayashi, MD, Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, 55 East 59th St, 6th Floor, New York, NY 10022. E-mail ykobayashi@crf.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 78-year-old man with a history of hypertension, hypercholesterolemia, and diabetes mellitus presented with acute anterior myocardial infarction in November 2002. Coronary angiography revealed total occlusions of the mid-left anterior descending coronary artery (LAD) and the right coronary artery, as well as ulcerations in the proximal LAD (Figure 1A). Coronary stenting was performed after predilatation. The final angiogram showed a good result (Figure 1B). Intravascular ultrasound (IVUS) imaging using a 40-MHz transducer (SCIMD/Boston Scientific Corporation) demonstrated not only optimal stent expansion, but also ruptured plaques in the proximal LAD and the mid-LAD proximal to the stented segment (Figures 2 and 3, top). Aspirin (81 mg daily), ticlopidine (100 mg twice daily), and an HMG-CoA reductase inhibitor were prescribed.

View larger version (72K): [in this window] [in a new window]   Figure 1. Coronary angiography showing total occlusion (arrow) of the mid-LAD (A). Note ulcerations in the proximal LAD (arrowheads). The final angiogram shows a good result (B). Follow-up angiography demonstrates haziness at the ostium of the LAD and ulcerations (arrowheads) in the proximal LAD (C).

View larger version (110K): [in this window] [in a new window]   Figure 2. Paired index (November 2002, top) and follow-up (April 2003, bottom) IVUS imaging are shown. Each study contains 4 image slices, 1 mm apart, acquired in the mid-LAD proximal to the stented segment. Between the 2 studies, lumen cross-sectional area decreased from 6.4 to 5.1 mm2 and external elastic membrane cross-sectional area increased from 16.0 to 18.6 mm2. Ruptured plaque has not healed; rather, the cavity size increased from 0.9 to 2.3 mm2 (arrows).

View larger version (66K): [in this window] [in a new window]   Figure 3. Paired index (November . . . [Full Text of this Article]