Layered coronary plaque associated with coronary vasospasm

2021 ◽  
Author(s):  
Kazuya Tateishi ◽  
Yuichi Saito ◽  
Takaaki Matsuoka ◽  
Hideki Kitahara ◽  
Yoshio Kobayashi
Keyword(s):  
Coronary Plaque ◽  
Coronary Vasospasm

scholarly journals The role of computed tomography coronary angiography in multi-vessel coronary vasospasm: a case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
James S Tomlinson ◽  
Amit Patel ◽  
Terry Levy
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Cold Pressor ◽  
Coronary Plaque ◽  
Coronary Vasospasm ◽  
Coronary Syndrome ◽  
Provocation Testing ◽  
Cold Pressor Testing

Abstract Background Coronary vasospasm can present like an acute coronary syndrome (ACS) with an intense vasoconstriction resulting in total or near-total occlusion of one or more of the coronary vessels. Definitive diagnosis can be made by intracoronary provocation testing. Case summary A 37-year-old Caucasian male and smoker was admitted with chest pain. Highly sensitive troponin-I was positive at 63 ng/L (99th percentile upper reference limit, <15 ng/L) with a repeat value of 45 ng/L three and a half hours later which was of clinical significance. Serial electrocardiography (ECG) showed no ischaemic changes. Coronary angiography revealed several distal and side branch stenoses; however, angiographic appearances were atypical of coronary plaque. A differential diagnosis of spontaneous coronary artery dissection was suspected although the patient was pain free during the procedure. Computed tomography coronary angiography (CTCA) demonstrated normal coronary arteries, confirmed on repeat invasive coronary angiography. Cold pressor testing was unsuccessful in reproducing vasospasm. Acute coronary syndrome treatment was discontinued, he received smoking cessation advice and Amlodipine 5 mg daily was started. He has experienced no further episodes of cardiac chest pain on follow-up consultation 7 months later. Discussion This is an unusual case of persistent, extensive coronary vasospasm in a patient without ongoing chest pain or ischaemic ECG changes. Intracoronary nitrates are usually effective at relieving coronary spasm. Cold pressor testing has poor sensitivity for diagnosing vasospasm when compared to intracoronary provocation testing using either acetylcholine or ergonovine. Multi-slice CTCA may help to discriminate coronary plaque from coronary vasospasm when there is diagnostic uncertainty.

Less Coronary Plaque in Young Hormone Users

2007 ◽  
Vol 37 (14) ◽  
pp. 15
Author(s):  
Mary Ann Moon
Keyword(s):  
Coronary Plaque

Improved myocardial perfusion preceding clinical response on bosentan treatment for coronary vasospasm

2009 ◽  
Vol 64 (3) ◽  
pp. 415-417 ◽  
Author(s):  
I.A.C. Vermeltfoort ◽  
P.G.H.M. Raijmakers ◽  
P.W. Kamphuisen
Keyword(s):  
Myocardial Perfusion ◽  
Clinical Response ◽  
Coronary Vasospasm

scholarly journals Repeatability Of Quantitative Pericoronary Adipose Tissue Attenuation And Coronary Plaque Burden From Coronary CT Angiography

2020 ◽  
Vol 14 (3) ◽  
pp. S81 ◽  
Author(s):  
P. McElhinney ◽  
E. Tzolos ◽  
M. Williams ◽  
S. Cadet ◽  
M. Dweck ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Coronary Ct

scholarly journals Integrated backscatter-intravascular ultrasound and modification of plaque during excimer laser coronary angioplasty

2021 ◽  
Author(s):  
Satoru Sasaki ◽  
Kenji Nakajima ◽  
Keizo Watanabe ◽  
Yudai Nozaki ◽  
Tadashi Yuguchi ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Excimer Laser ◽  
Coronary Angioplasty ◽  
Coronary Plaque ◽  
Cross Sectional ◽  
Integrated Backscatter ◽  
Before And After ◽  
Vessel Volume ◽  
Integrated Backscatter Intravascular Ultrasound ◽  
Excimer Laser Coronary Angioplasty

AbstractThis study aims to test the hypothesis that the effect of excimer laser coronary angioplasty (ELCA) not only vaporizes thrombi and their underlying coronary plaque, it also changes their quality. We performed a series of cross-sectional analyses in 52 lesions in 51 patients before and after ELCA with integrated backscatter-intravascular ultrasound (IB-IVUS). The constituent parts of the plaque can be assessed by IB-IVUS (i.e., calcified, fibrous, lipid) according to integrated backscatter values. Minimum lumen diameter, lumen volume and vessel volume expanded after ELCA, while plaque volume did not significantly decrease. There was also a decrease of ‘lipid’ component (35.4–30.3%, P < 0.001) and an increase of IB-IVUS-derived ‘fibrous’ part (34.5–38.3%, P < 0.001). These results may help in understanding plaque change after ELCA. Excimer laser coronary angioplasty seems to contribute to the modification of coronary plaque composition in addition to debulking it.

scholarly journals Clinical Relevance of Coronary Computed Tomography Angiography Beyond Coronary Artery Stenosis

2021 ◽  
Author(s):  
Mohammed Nooruddin Meah ◽  
Michelle C. Williams
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
High Risk ◽  
Atherosclerotic Plaque ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Calcium Score ◽  
Coronary Plaque ◽  
Coronary Computed Tomography ◽  
Low Attenuation Plaque

Background The capabilities of coronary computed tomography angiography (CCTA) have advanced significantly in the past decade. Its capacity to detect stenotic coronary arteries safely and consistently has led to a marked decline in invasive diagnostic angiography. However, CCTA can do much more than identify coronary artery stenoses. Method This review discusses applications of CCTA beyond coronary stenosis assessment, focusing in particular on the visual and quantitative analysis of atherosclerotic plaque. Results Established signs of visually assessed high-risk plaque on CT include positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, which correlate with the histological thin-cap fibroatheroma. Recently, quantification of plaque subtypes has further improved the assessment of coronary plaque on CT. Quantitatively assessed low-attenuation plaque, which correlates with the necrotic core of the thin-cap fibroatheroma, has demonstrated superiority over stenosis severity and coronary calcium score in predicting subsequent myocardial infarction. Current research aims to use radiomic and machine learning methods to further improve our understanding of high-risk atherosclerotic plaque subtypes identified on CCTA. Conclusion Despite rapid technological advances in the field of coronary computed tomography angiography, there remains a significant lag in routine clinical practice where use is often limited to lumenography. We summarize some of the most promising techniques that significantly improve the diagnostic and prognostic potential of CCTA. Key Points:  Citation Format

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