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CT evaluation of vulnerable plaque: noninvasive fortune-telling?

Opolski MP, Kepka C, Witkowski A - Int J Cardiovasc Imaging (2011)

Bottom Line: Recently, cardiac CTA has been proposed as a promising noninvasive tool for identification of rupture-prone plaques prior to a subsequent coronary event.This task is particularly challenging but the reward is high: identification of high-risk lesions could preclude plaque thrombosis and possibly prevent acute coronary syndromes.After 6 months and despite aggressive medical therapy, the patient developed acute ST-elevation myocardial infarction caused by a thrombotic lesion in the proximal LAD.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland. maxopol@gmail.com

ABSTRACT
Recently, cardiac CTA has been proposed as a promising noninvasive tool for identification of rupture-prone plaques prior to a subsequent coronary event. This task is particularly challenging but the reward is high: identification of high-risk lesions could preclude plaque thrombosis and possibly prevent acute coronary syndromes. We present a case of a borderline mixed plaque with positive remodeling in the proximal left anterior descending artery (LAD). After 6 months and despite aggressive medical therapy, the patient developed acute ST-elevation myocardial infarction caused by a thrombotic lesion in the proximal LAD. We review the literature on CT characteristics of vulnerable plaque and discuss the possible preventive interventions.

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a Curved multiplanar reconstruction of a high-risk lesion in the proximal left anterior descending artery (LAD) causing future ischemic event. b–f Serial cross sections demonstrating mixed plaque with low attenuation area proximal to calcium spots and positive remodeling. g, h Left coronary angiography showing high-grade thrombotic lesion (arrowheads) in the proximal LAD. LAD left anterior descending artery, LCX left circumflex
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Fig1: a Curved multiplanar reconstruction of a high-risk lesion in the proximal left anterior descending artery (LAD) causing future ischemic event. b–f Serial cross sections demonstrating mixed plaque with low attenuation area proximal to calcium spots and positive remodeling. g, h Left coronary angiography showing high-grade thrombotic lesion (arrowheads) in the proximal LAD. LAD left anterior descending artery, LCX left circumflex

Mentions: A 59-year-old male with atypical chest pain and intermediate pretest probability underwent dual-source computed tomography angiography (CTA). CTA was performed with 80 ml contrast agent at 6.0 ml/s, 100 kV tube voltage and retrospective ECG-gated protocol (slice thickness, 0.6 mm; overlap, 0.4 mm) with radiation exposure of 12.1 mSv. Multiplanar reconstructions demonstrated a borderline (60% luminal stenosis) mixed plaque in the proximal segment of left anterior descending artery (LAD) and mild atherosclerotic lesions in the left circumflex and right coronary artery with total calcium Agatston score of 678 (Fig. 1a). Cross-sectional images of LAD demonstrated a mixed plaque with low attenuation area proximal to calcium spots and positive remodeling (Fig. 1b–f). Based on patient’s preferences, aggressive medical therapy with a high-dose statin, aspirin and antihypertensive agents was initiated. After 6 months the patient presented with acute anterior ST-elevation myocardial infarction caused by thrombotic lesion in the proximal LAD (Fig. 1g, h). Although he underwent primary percutaneous coronary intervention of the culprit LAD, NYHA class II heart failure symptoms developed.Fig. 1


CT evaluation of vulnerable plaque: noninvasive fortune-telling?

Opolski MP, Kepka C, Witkowski A - Int J Cardiovasc Imaging (2011)

a Curved multiplanar reconstruction of a high-risk lesion in the proximal left anterior descending artery (LAD) causing future ischemic event. b–f Serial cross sections demonstrating mixed plaque with low attenuation area proximal to calcium spots and positive remodeling. g, h Left coronary angiography showing high-grade thrombotic lesion (arrowheads) in the proximal LAD. LAD left anterior descending artery, LCX left circumflex
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3473186&req=5

Fig1: a Curved multiplanar reconstruction of a high-risk lesion in the proximal left anterior descending artery (LAD) causing future ischemic event. b–f Serial cross sections demonstrating mixed plaque with low attenuation area proximal to calcium spots and positive remodeling. g, h Left coronary angiography showing high-grade thrombotic lesion (arrowheads) in the proximal LAD. LAD left anterior descending artery, LCX left circumflex
Mentions: A 59-year-old male with atypical chest pain and intermediate pretest probability underwent dual-source computed tomography angiography (CTA). CTA was performed with 80 ml contrast agent at 6.0 ml/s, 100 kV tube voltage and retrospective ECG-gated protocol (slice thickness, 0.6 mm; overlap, 0.4 mm) with radiation exposure of 12.1 mSv. Multiplanar reconstructions demonstrated a borderline (60% luminal stenosis) mixed plaque in the proximal segment of left anterior descending artery (LAD) and mild atherosclerotic lesions in the left circumflex and right coronary artery with total calcium Agatston score of 678 (Fig. 1a). Cross-sectional images of LAD demonstrated a mixed plaque with low attenuation area proximal to calcium spots and positive remodeling (Fig. 1b–f). Based on patient’s preferences, aggressive medical therapy with a high-dose statin, aspirin and antihypertensive agents was initiated. After 6 months the patient presented with acute anterior ST-elevation myocardial infarction caused by thrombotic lesion in the proximal LAD (Fig. 1g, h). Although he underwent primary percutaneous coronary intervention of the culprit LAD, NYHA class II heart failure symptoms developed.Fig. 1

Bottom Line: Recently, cardiac CTA has been proposed as a promising noninvasive tool for identification of rupture-prone plaques prior to a subsequent coronary event.This task is particularly challenging but the reward is high: identification of high-risk lesions could preclude plaque thrombosis and possibly prevent acute coronary syndromes.After 6 months and despite aggressive medical therapy, the patient developed acute ST-elevation myocardial infarction caused by a thrombotic lesion in the proximal LAD.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland. maxopol@gmail.com

ABSTRACT
Recently, cardiac CTA has been proposed as a promising noninvasive tool for identification of rupture-prone plaques prior to a subsequent coronary event. This task is particularly challenging but the reward is high: identification of high-risk lesions could preclude plaque thrombosis and possibly prevent acute coronary syndromes. We present a case of a borderline mixed plaque with positive remodeling in the proximal left anterior descending artery (LAD). After 6 months and despite aggressive medical therapy, the patient developed acute ST-elevation myocardial infarction caused by a thrombotic lesion in the proximal LAD. We review the literature on CT characteristics of vulnerable plaque and discuss the possible preventive interventions.

Show MeSH
Related in: MedlinePlus