Author + information
- Received March 22, 2018
- Accepted April 10, 2018
- Published online July 16, 2018.
- Masahiro Hoshino, MDa,
- Taishi Yonetsu, MDa,
- Yoshihito Yuki, MDa,
- Kazunari Inoue, MDb,
- Yoshihisa Kanaji, MDa,
- Eisuke Usui, MDa,
- Tetsumin Lee, MD, PhDa and
- Tsunekazu Kakuta, MD, PhDa,∗ ()
- aDepartment of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
- bDepartment of Pathology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
- ↵∗Address for correspondence:
Dr. Tsunekazu Kakuta, Tsuchiura Kyodo General Hospital, Department of Cardiovascular Medicine, 4-1-1, Otsuno, Tsuchiura, Ibaraki 300-0028, Japan.
- acute coronary syndrome(s)
- coronary artery disease
- intraplaque hemorrhage
- intravascular ultrasound
- optical coherence tomography
Intraplaque hemorrhage (IPH) has been reported to be one of the causes of atherosclerotic plaque progression and acute coronary syndrome, in which intravascular ultrasound images showed greater plaque burden and echolucent region corresponding to histopathologic IPH (1). However, the typical appearance of IPH on optical coherence tomography is unknown.
The patient was a 54-year-old man diagnosed with unstable angina. Coronary angiography revealed a significant stenosis of the proximal left anterior descending coronary artery. Percutaneous coronary intervention was performed by using directional coronary atherectomy following multimodality intracoronary preprocedural imaging (Figure 1). Intracoronary images with 60-MHz intravascular ultrasound showed a superficial crescent-shaped echolucent plaque, which was distinguished from adjacent calcification. Optical coherence tomographic images also revealed a clearly bordered, crescent-shaped low-signal region adjacent to the calcification. Pathological examination of the specimen including the aforementioned crescent-shaped region obtained with directional coronary atherectomy showed a hemorrhage with macrophage accumulation within fibrous tissue. Because pathological findings did not exhibit disintegration of neutrophil nucleus or hemosiderin deposition, this IPH was considered to be an early stage after hemorrhage.
This is the first description of optical coherence tomographic assessment of IPH, which was validated by typical intravascular ultrasound features of an echolucent region and histopathologic IPH validation.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 22, 2018.
- Accepted April 10, 2018.
- 2018 American College of Cardiology Foundation