Figure 3 Management of acute coronary syndrome with intact fibrous cap

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Presentation transcript:

Figure 3 Management of acute coronary syndrome with intact fibrous cap Figure 3 | Management of acute coronary syndrome with intact fibrous cap. A case report from Prati and colleagues28 described a man aged 66 years who was admitted to hospital with severe chest discomfort and shortness of breath. a | An electrocardiogram revealed ST-segment elevation in precordial leads. An emergency coronary angiography was performed 4 h after the onset of chest pain, which revealed total occlusion of the proximal segment of the left anterior descending coronary artery. b,c | Repeat coronary angiography demonstrated no thrombus or stenosis at the original site of total occlusion. Optical coherence tomography (OCT), angioscopy, grey-scale intravascular ultrasonography (IVUS), and integrated backscatter IVUS were performed. Coronary angioscopy showed faint red thrombus formation through the blue coronary angioscopy guide catheter, whereas OCT did not show a typical red thrombus with a high backscattering protrusion mass with signal-free shadowing, but some signal reduction was observed (panel c). Multiple slices of OCT images revealed an intact fibrous cap (panel b). IVUS and integrated backscatter IVUS demonstrated predominantly a fibrous plaque (green) and negligible lipid-rich component (blue; panel c). No intervention was undertaken. d | Predischarge curved multiplanar reconstruction CT images confirmed the absence of positive remodelling, no clinically significant stenosis at the site of the original occlusion, and mainly normal coronary arteries. Reprinted from Prati, F. et al. OCT-based diagnosis and management of STEMI associated with intact fibrous cap. JACC Cardiovasc. Imaging 6, 283–287 © (2013), with permission from Elsevier. Reprinted from Prati, F. et al. OCT-based diagnosis and management of STEMI associated with intact fibrous cap. JACC Cardiovasc. Imaging 6, 283–287 © (2013), with permission from Elsevier Akasaka, T. & Narula, J. et al. (2016) Acute coronary syndromes without coronary plaque rupture Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.19