Background

Recent studies showed that evolocumab significantly reduces the risk of cardiovascular events in stable lesions. However, there are few reports to examine changes in lipid content of the non-culprit lesion measured by NIRS-IVUS.

Case

A 57 years male subject with a history of dyslipidemia presented with chest pain. His culprit lesion was in the proximal left circumflex (LCX), and he also had a moderate stenosis in mid right coronary artery (RCA). We performed percutaneous coronary intervention (PCI) for the lesion in proximal LCX.

Decision-making

We simultaneously analyzed the non-culprit lesion in mid part of RCA by using near-infrared intravascular ultrasonography (NIRS-IVUS). The max Lipid Core Burden Index (LCBI) in the non-culprit lesion was high (Figure1 A). He received subcutaneous injections of evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (420 mg every month), and also received Rosuvastatin 5 mg. Then his serum low-density lipoprotein (LDL) cholesterol levels were decreased from 144 to 17 mg/dl. After six months, we followed up for the RCA lesion by NIRS-IVUS. We confirmed that the max LCBI in the non-culprit RCA lesion after evolocumab injections were significantly decreased (Figure 1B).

Conclusion

In this case, it was suggested that the plaque morphology can be altered by the combination therapy of statins and evolocumab injection and NIRS-IVUS can detect the plaque stabilization of non-culprit lesion in ACS patients.

Footnotes