Acute Coronary Syndrome Demonstrating Plaque Rupture in Calcified Lesions Visualized by Optical Frequency Domain Imaging
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- Goryo Yutaka
- Department of Cardiology, Kawasaki Medical School
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- Kume Teruyoshi
- Department of Cardiology, Kawasaki Medical School
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- Kobayashi Yusuke
- Department of Cardiology, Kawasaki Medical School
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- Okamoto Hiroshi
- Department of Cardiology, Kawasaki Medical School
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- Kawamura Ai
- Department of Cardiology, Kawasaki Medical School
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- Fukuhara Kenzo
- Department of Cardiology, Kawasaki Medical School
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- Koyama Terumasa
- Department of Cardiology, Kawasaki Medical School
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- Yamada Ryotaro
- Department of Cardiology, Kawasaki Medical School
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- Imai Koichiro
- Department of Cardiology, Kawasaki Medical School
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- Neishi Yoji
- Department of Cardiology, Kawasaki Medical School
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- Uemura Shiro
- Department of Cardiology, Kawasaki Medical School
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抄録
<p>A 68-year-old female with acute coronary syndrome was transferred to our hospital. Emergency coronary angiography showed 90% stenosis with severe calcification in the proximal right coronary artery (RCA). Intravascular ultrasound (IVUS) images were obtained and showed circumferential heavy calcification without any evidence of plaque rupture. Optical frequency domain imaging (OFDI) images were obtained in the RCA lesion 3 days after the initial coronary angiography. A cavity of plaque rupture in the calcified plaque by using OFDI was observed in the lesion, which could not be recognized by IVUS. Necrotic tissue was observed frequently in heavy calcified lesions and was usually hidden behind calcification. Judging from the OFDI images in this case, the thin fibrous cap over the necrotic tissue even if surrounded by calcification was disrupted and might have caused the acute coronary syndrome. However, necrotic tissue surrounded by calcification is generally recognized as calcified plaque in OFDI images because discrimination between necrotic tissue and calcification is based on the border characteristics (low intensity with diffuse border: necrotic tissue, low intensity with sharp border: calcification). Superficial residual necrotic tissue not yet replaced completely by calcification might cause plaque rupture and thus, result in acute coronary syndrome. In fact, there is a variety of OFDI and optical coherence tomography (OCT) characteristics in calcified plaque, such as relatively high intensity without attenuation or very low intensity with attenuation. Residual necrotic tissue within calcification could pose a problem in OCT/OFDI plaque evaluation.</p>
収録刊行物
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- International Heart Journal
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International Heart Journal 58 (1), 131-133, 2017
一般社団法人 インターナショナル・ハート・ジャーナル刊行会