Author + information
- Received February 23, 2016
- Accepted March 11, 2016
- Published online June 27, 2016.
- Hiroshi Koiwaya, MD, PhDa,b,
- Nobuhiro Tahara, MD, PhDa,∗ (, )
- Atsuko Tahara, MDa,
- Akihiro Honda, MDa,
- Sachiyo Igata, PhDa,
- Munehisa Bekki, MDa,
- Tomohisa Nakamura, MDa,
- Yoichi Sugiyama, MDa,
- Masanori Ohtsuka, MD, PhDa,
- Seiji Kurata, MD, PhDc,
- Kiminori Fujimoto, MD, PhDc,
- Toshi Abe, MD, PhDc,
- Yoshisato Shibata, MDb,
- Takafumi Ueno, MD, PhDa and
- Yoshihiro Fukumoto, MD, PhDa
- aDepartment of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan
- bCardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
- cDepartment of Radiology, Kurume University School of Medicine, Kurume, Japan
- ↵∗Reprint requests and correspondence:
Dr. Nobuhiro Tahara, Department of Medicine, Division of Cardiovascular Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
An 83-year-old man was transferred to our hospital due to worsening effort angina pectoris. Electrocardiogram during chest pain at rest showed ST-segment elevation with hyperacute T waves and negative U waves in leads V2 through V4 (Figure 1A). Sublingual administration of nitroglycerin relieved him from chest pain, when electrocardiogram showed inverted T waves (Figure 1B). Biomarkers of myocardial injury were not elevated. Coronary computed tomography angiography (CTA) indicated a severe stenosis in the distal left main coronary artery (LMCA) to the proximal left anterior descending artery (LAD) (Figure 1C, yellow arrows). 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) combined with coronary CTA demonstrated the intense FDG uptake at the corresponding segment (Figure 1D, red arrows). Selective coronary angiography of the left coronary artery showed an ulcer-like severe stenosis in the distal LMCA to the proximal LAD, which we considered as a culprit lesion (Figure 1E). Next, we evaluated the coronary atherosclerotic plaque by grayscale intravascular ultrasound (IVUS) (Figures 1F to 1H), IVUS-virtual histology (Figures 1I to 1K) and optical coherence tomography (OCT) (Figures 1L to 1N). Grayscale IVUS of the culprit lesion demonstrated a substantial amount of plaque burden (Figures 1F to 1H). Fibrofatty and necrotic core components were detected within the eccentric plaque by IVUS-virtual histology (Figures 1I to 1K). OCT revealed not only a thin-cap fibroatheroma but also a dark region, suggesting a macrophage-rich region at the distal LMCA (Figure 1N, red arrow). After we evaluated the atherosclerotic plaque images, we successfully performed percutaneous coronary intervention without concomitant complication. This is the first documentation of in vivo molecular imaging of ruptured coronary atherosclerotic plaque by IVUS, OCT, and FDG-PET/CT.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 23, 2016.
- Accepted March 11, 2016.
- American College of Cardiology Foundation