Author + information
- Received August 7, 2009
- Revision received October 21, 2009
- Accepted October 26, 2009
- Published online July 20, 2010.
- Carl J. Schultz, MD, PhD*,
- Patrick W. Serruys, MD, PhD*,
- Martin van der Ent, MD, PhD*,
- Jurgen Ligthart, MSc*,
- Frits Mastik†,
- Scott Garg, MD, PhD*,
- James E. Muller, MD‡,
- Mark A. Wilder, MSc‡,
- Anton F.W. van de Steen, MSc, PhD† and
- Evelyn Regar, MD, PhD*
A 57-year-old male with a previous myocardial infarction and primary stenting of the right coronary artery was admitted for treatment of a type A lesion in the proximal left anterior descending coronary artery (E). Fractional flow reserve was 0.68, and complex partly calcific plaque morphology was seen on multislice computed tomography (D). A novel intravascular ultrasound (IVUS) and near-infrared spectroscopic combination catheter demonstrated lipid-rich plaque extending almost 270° of the vessel circumference (A to C). Direct stenting (everolimus-eluting, 3.5 × 18 mm) obtained an excellent angiographic result (E). After the procedure, the patient experienced mild transient chest discomfort without electrocardiographic changes, but cardiac enzymes were elevated (troponin T 0.89 ng/ml, creatine kinase 239 U/l, myocardial band fraction 10%).
Distal embolization of disrupted lipid-rich plaque has been proposed as one potential cause of unanticipated myocardial injury after stenting and the no-reflow phenomenon. Combined near-infrared spectroscopy and IVUS offers a new method for investigating this “cheese grater effect” hypothesis, although further validation is needed.
- Received August 7, 2009.
- Revision received October 21, 2009.
- Accepted October 26, 2009.
- American College of Cardiology Foundation