High-risk calcified plaque preoperatively detected by non-contrast T1-weighted magnetic resonance imaging and electrocardiogram-gated computed tomography

A 76-year-old man with chronic kidney disease presented with worsening angina pectoris. Coronary angiography (CAG) revealed an ischaemia-inducible stenosis in the distal left main trunk (LMT), continuing to the proximal left anterior descending artery (Panel A). Non-contrast electrocardiogram (ECG)-gated computed tomography (CT) showed a heavily calcified plaque with a low-intensity area surrounded by high-intensity signals (dark-crescent sign) in the distal LMT; non-contrast T1-weighted magnetic resonance imaging (T1WI) revealed the presence of a high-intensity plaque (HIP) (Panels B –D). Intravascular ultrasound (Panel E) and optical coherence tomography (Panel F) during intervention revealed a minimum lumen area (2.9 cm2). Nonetheless, both were unable to discriminate the overall characteristics of the calcified plaque. However, the preoperatively obtained images on non-contrast ECG-gated CT and non-contrast T1WI suggested that the LMT plaque potentially involved vulnerable plaque components; therefore, minimally invasive intervention with drug-coated balloon angioplasty was performed without atheroablation, under distal protection, achieving optimal results and avoiding the slow-flow phenomenon. One-year follow-up CAG showed no ischaemia-inducible restenosis (Panel G).
Source: European Heart Journal - Category: Cardiology Source Type: research