Combined Use of Multiple Intravascular Imaging Techniques in Acute Coronary Syndrome

Recent advances in intravascular imaging techniques have made it possible to assess the culprit lesions of acute coronary syndrome (ACS) in the clinical setting. Intravascular ultrasound (IVUS) is the most commonly used intravascular imaging technique that provides cross-sectional images of coronary arteries. IVUS can assess plaque burden and vessel remodeling. Optical coherence tomography (OCT) is a high-resolution (10 μm) intravascular imaging technique that uses near-infrared light. OCT can identify key features of atheroma, such as lipid core and thin fibrous cap. Near-infrared spectroscopy (NIRS) can detect lipid composition by analyzing the near-infrared absorption properties of coronary plaques. NIRS provides a chemogram of the coronary artery wall, which allows for specific quantification of lipid accumulation. These intravascular imaging techniques can depict histological features of plaque rupture, plaque erosion, and calcified nodule in ACS culprit lesions. However, no single imaging technique is perfect and each has its respective strengths and limitations. In this review, we summarize the implications of combined use of multiple intravascular imaging techniques to assess the pathology of ACS and guide lesion-specific treatment.

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Acute coronary syndrome with large thrombus successfully managed with no-stenting revascularization based on intravascular imaging in a patient with hyperhomocysteinemia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02531-5 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Keisuke Shoji ◽

Kenji Yanishi ◽

Noriyuki Wakana ◽

Naohiko Nakanishi ◽

Kan Zen ◽

...

Keyword(s):

Pulmonary Embolism ◽

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Deep Vein Thrombosis ◽

Near Infrared ◽

Intravascular Imaging ◽

Intravascular Ultrasonography ◽

Vein Thrombosis ◽

Coronary Syndrome ◽

Deep Vein

Abstract Background Hyperhomocysteinemia is caused by genetic and environmental factors, which can result in systemic arteriosclerosis and arteriovenous thrombosis including acute coronary syndrome. Thrombus burden in patients with acute coronary syndrome and hyperhomocysteinemia might involve the culprit lesion as compared with those without any coagulopathy. The primary percutaneous coronary intervention with stent implantation had been established as the treatment strategy for patients with acute coronary syndrome. However, in patients with acute coronary syndrome with high thrombus burden or uncontrolled coagulopathy, stent implantation might lead to slow-flow phenomenon or stent thrombosis. Therefore, the treatment strategy in these patients was not established. Case presentation A 49-year-old Japanese man with history of splenic infarction of unknown cause had continued anticoagulant therapy since its diagnosis, but stopped taking the medication several months ago. He presented with sudden-onset chest dorsalgia. Contrast computed tomography showed a small pulmonary embolism and his troponin I level was elevated on initial laboratory test. Coronary angiography revealed a contrast defect caused by a large thrombus from the proximal to mid portion of the left anterior descending artery. Near-infrared spectroscopy–intravascular ultrasonography showed a large amount of thrombus without lipid plaque. Therefore, revascularization was performed using a thrombus-aspiration catheter and intracoronary thrombolysis. In addition, , hyperhomocysteinemia and a deep vein thrombosis occurred. He was diagnosed with acute coronary syndrome complicated with pulmonary embolism and deep vein thrombosis simultaneously induced by hyperhomocysteinemia. After 1 week of antithrombotic therapy, near-infrared spectroscopy–intravascular ultrasonography and optical coherence tomography revealed a decreased thrombus and no significant residual organic stenosis in the left anterior descending artery. He continued conservative therapy with antithrombotic medications including aspirin and warfarin and had no cardiovascular events after discharge. Follow-up coronary angiography and optical coherence tomography at 9 months revealed complete disappearance of the thrombus and no severe stenosis. Conclusions Hyperhomocysteinemia should be considered as a cause of arterial vein thrombosis of unknown cause. The antithrombotic therapy and percutaneous revascularization without stenting based on intravascular imaging might be a safe and effective treatment option in patients with acute coronary syndrome complicated with hyperhomocysteinemia.

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Coronary lipid-rich plaque characteristics in Japanese patients with acute coronary syndrome and stable angina: A near infrared spectroscopy and intravascular ultrasound study

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100747 ◽

2021 ◽

Vol 33 ◽

pp. 100747

Author(s):

Norihito Takahashi ◽

Tomotaka Dohi ◽

Hirohisa Endo ◽

Mitsuhiro Takeuchi ◽

Shinichiro Doi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Infrared Spectroscopy ◽

Intravascular Ultrasound ◽

Near Infrared Spectroscopy ◽

Stable Angina ◽

Near Infrared ◽

Japanese Patients ◽

Coronary Syndrome ◽

Ultrasound Study ◽

Lipid Rich Plaque

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Combined Use of Warfarin and Oral P2Y12 Inhibitors in Patients With Atrial Fibrillation and Acute Coronary Syndrome

Clinical Cardiology ◽

10.1002/clc.22231 ◽

2013 ◽

Vol 37 (3) ◽

pp. 152-159 ◽

Cited By ~ 1

Author(s):

W. Schuyler Jones ◽

Xiaojuan Mi ◽

Manesh R. Patel ◽

Roger Mills ◽

Adrian F. Hernandez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

P2y12 Inhibitors ◽

Coronary Syndrome ◽

Combined Use

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The role of chronic obstructive pulmonary disease in acute coronary syndrome patients: a critical risk factor for lipid plaque burden?

Minerva Cardiology and Angiology ◽

10.23736/s0026-4725.20.05555-3 ◽

2021 ◽

Author(s):

Francesco Piroli ◽

Antonio M. Leone ◽

Simone Calcagno

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Acute Coronary Syndrome ◽

Risk Factor ◽

Pulmonary Disease ◽

Plaque Burden ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Coronary Syndrome

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Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001595 ◽

2020 ◽

Author(s):

Tara Burleigh ◽

Khandalavala Birgit

Keyword(s):

Acute Coronary Syndrome ◽

Case Report ◽

Left Ventricular ◽

Ventricular Wall ◽

Takotsubo Syndrome ◽

Coronary Syndrome ◽

First Case ◽

Combined Use ◽

Menopausal Women ◽

Post Menopausal

Objectives: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine. Background: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently. Results: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care. Conclusion: Caution with the use of sympathomimetic medications in post-menopausal women appears warranted.

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Evaluation of human coronary vasodilator function predicts future coronary atheroma progression

Heart ◽

10.1136/heartjnl-2017-312579 ◽

2018 ◽

Vol 104 (17) ◽

pp. 1439-1446 ◽

Cited By ~ 1

Author(s):

Samuel L Sidharta ◽

Timothy J Baillie ◽

Stuart Howell ◽

Stephen J Nicholls ◽

Natalie Montarello ◽

...

Keyword(s):

Near Infrared ◽

Coronary Plaque ◽

Plaque Burden ◽

Plaque Progression ◽

Independent Function ◽

Lipid Core ◽

Coronary Syndrome ◽

Coronary Vasodilator ◽

Dependent Function ◽

The Relationship

ObjectiveCoronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.Methods33 patients with stable chest pain or acute coronary syndrome underwent serial assessment of coronary vasodilator function and intracoronary plaque IVUS and NIRS imaging. Coronary segmental macrovascular response (% change segmental lumen volume (ΔSLV)), plaque burden (per cent atheroma volume (PAV)), lipid core (lipid-rich plaque (LRP) and lipid core burden index (LCBI)) were measured at baseline and after an interval of 12–18 months (n=520 segments).ResultsLipid-negative coronary segments which develop into LRP over the study time period demonstrated impaired endothelial-dependent function (−0.24±2.96 vs 5.60±1.47%, P=0.04) and endothelial-independent function (13.91±4.45 vs 21.19±3.19%, P=0.036), at baseline. By multivariate analysis, endothelial-dependent function predicted ∆LCBI (β coefficient: −3.03, 95% CI (−5.81 to −0.25), P=0.033) whereas endothelial-independent function predicted ∆PAV (β coefficient: 0.07, 95% CI (0.04 to 0.10), P<0.0001).ConclusionsEpicardial coronary vasodilator function is a determinant of future atheroma progression and composition irrespective of the nature of clinical presentation.Trial registration numberACTRN12612000594820, Post-results.

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