Unmet Need for Deep Diving into Intracoronary Imaging

İngilizce (OpenAlex)

To the Editor, We have read this interesting case report by the authors with great excitement. 1 A 28-year-old man presented with anterolateral ST-segment elevation myocardial infarction after heavy alcohol and energy drink consumption.Coronary angiography revealed a massive thrombus at the left anterior descending (LAD) artery ostium, which was successfully treated with a combination of balloon angioplasty, thrombus aspiration, and potent antiaggregant drugs without stent implantation.In addition, intravascular ultrasound (IVUS) modality was utilized to better understand the characteristics of the culprit lesion (CL). 1 Plaque rupture, thin-cap fibroatheroma, and red thrombus formation are frequently reported in the CLs causing acute coronary syndrome (ACS). 2 In a review of 7526 ACS patients with a mean age of 62.4 years, CL morphologies were investigated using optic coherence tomography (OCT).Accordingly, plaque rupture was the predominant CL morphology and thincap fibroatheroma was observed in 45% of all ACS patients.3 In the ACS population between 18-50 years of age, plaque rupture and plaque erosion on a fibrous plaque background is the main histopathologic finding in the CLs, and calcific nodules are more rarely identified.4 In an OCT-based prospective-observational study, in histopathologic groups with both plaque rupture and plaque erosion, the frequency of thin-cap fibroatheroma, microchannel, and macrophage density were found to be lower, but fibrous cap thickness and intimal thickness were found to be higher in the ACS population younger than 35 years compared to those older than 35 years.5