Optical coherence tomography assessment of vulnerable plaque rupture: predilection for the plaque ‘shoulder’

Extract

Atherosclerosis as a disease entity remains an intensely researched field, given the tendency for considerable morbidity and mortality. This attention has given rise to exciting opportunities in developing tools aimed at early detection and possible targeting of specific therapeutic interventions. One such modality is optical coherence tomography (OCT) that permits high-resolution visualization of backscattered light. This has given unique insights into disease processes and with greater detail than traditional grey scale intravascular ultrasound (IVUS). We present a 69-year-old man with 1 week crescendo angina 9 months following stent implantation to the left anterior descending (LAD) artery. Angiography demonstrated a new lesion in the mid LAD and diagonal branches. Assessment of the region with OCT revealed a high lipid content plaque with a thin fibrous cap (maximal thickness = 20 µm). In association, rupture of the thin cap was apparent, occurring at both shoulders of the plaque with associated mural thrombus. The patient was treated with further stent implantation and remains symptom-free at 3 months follow-up.