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Widespread Coronary Vulnerable Plaques in Patient with Acute Coronary Syndrome
- Operator : Myeong-Ki Hong MD, PhD, Korea
Case presentation
The patient was 72 year-old man and was presented with resting chest for 2 days. Baseline echocardiography showed normal left ventricular function without regional wall motion abnormality. Coronary angiography was performed for evaluation and management of chest pain. Both coronary angiogram revealed multiple stenotic lesion intraluminal haziness. (Figure 1, Figure 2, Figure 3). To evaluate these lesions, Intravascular ultrasound (IVUS) was performed in all 3 epicardial arteries (LAD: Figure 4, LCX: Figure 5, RCA: Figure 6). Multiple vulnerable plaques (plaque rupture, plaque excavation, plaque with intraplaque echolucent zone or plaque containing with thrombus) were noted across three vessels. LAD and RCA lesions were treated with stents (Figure 7, Figure 8), but LCX lesion without significant stenosis was not stented. Aspirin, clopidogrel, beta-blocker, and lipid lowering agent continued to be adminstered for plaque stabilization
Marcelo Ribeiro2003-12-08
We clearly could see the widespread character of coronary obstructive disease in this patient, with 3 vessel disease as opposed to the 2 vessel involvement detected by angiography .There were lesions with vulnerable features both in LAD and CX ,and obviously in the Right . So this patient has a pancoronary proccess going on , and thanks to IVUS Dr wwwwww were able to detect. We should now understand that we already have a good invasive method to see vulnerable lesions,namely IVUS,,which will improve more and more. Now we have to develop a noninvasive, reliable method to detect this and,more important , define the best approach to this problem. Thank you very much indeed for this case.
Dear Dr. Myeong-Ki Hong, Do you know of any randomized clinical/ angiographic/IVUS data that suggests that in the absence of an obviously flow limiting stenosis (by IVUS criteria) that treating a vulnerable/ruptured plaque by stent coverage (drug eluting or otherwise) is better or worse than best medical therapy? ie. Does covering the plaque (assuming we don't have embolization or dissection) inherently stabilize it or destabilize it with respect to "aggressive"" medical therapy --which all these patients should be getting anyway! thanks and great provocative case-your site is very educational.
Young-Hak Kim2003-12-08
Dr Hong MK and we, angioplasty summit, appreciate your comments for this case. There are a lot of debates about detection and treatment of vulnerable plaques. However, to our knowledge, the long-term fate of vulnerable plaques with or without treatment has not been reported. Therefore, Dr. Hong thinks that the treatment strategy-PCI or medical- should be selected by the lesion MLD or cross sectional area by IVUS examination until a more advanced diagnostic toll and more data are introduced.
jamal Al-Atawneh2003-12-12
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