Crater and Cavity-like Coronary Plaque followed on the Rupture
Masamichi Takano, Kyoichi Mizuno, Koji Seimiya
Nippon Medical School, Chiba-Hokusoh Hospital
A 60-year-old man complained severe chest pain for 50 minutes and visited our hospital. Electrocardiogram showed hyperacute T wave in V2-V5 leads. The leukocyte count was elevated (123.40/mm3) and the serum level of creatine phosphokinase (CK) was within normal range (160 U/L). Ventricular tachycardia regarded as reperfusion arrhythmia was appeared after intravenous coronary thrombosis, and then chest pain and hyperacute T wave were disappeared. The peak CK was 408 U/L and the peak CK-MB isoenzyme was 22 U/L.
Coronary angiogram on the 16th day after admission showed 75% stenosis in the mid left anterior descending artery. This culprit lesion was observed by coronary angioscopy and intravascular ultrasound (IVUS). Ruptured atherosclerotic yellow plaque accompanied with residual red thrombus was noted by angioscopy. Torn intima appeared "crater-like" and the inside of the plaque could be seen (arrow in Figure A). Cross-sectional image by IVUS showed eccentric plaque with thin fibrous cap (arrow in Figure B). The plaque content had been partially washed out and negative contrast media (heparinized saline) was injected into the plaque. "Cavity-like" space under the fibrous cap could be seen clearly. These intracoronary images let us imagine typical vulnerable plaque.
Figure legend
UPPER Coronary Angioscopic Image. Intima of the yellow plaque was disrupted and looked "crater-like" (arrow). Residual red thrombus (T) and the 0 014 inch guide wire (GW) were also seen.
LOWER Intravascular Ultrasound Image. Part of the plaque contents had been washed out. Under the fibrous cap (arrow), "cavity-like" space was noted.
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