Acute Coronary Syndrome with Non-Obstructive Plaque on Angiography and Features of Vulnerable Plaque on Intracoronary Optical Coherence Tomography

Figure 1. Electrocardiogram showing ST-segment elevation in the anterior (V1–V4) and lateral leads (V5, V6, I, aVL) with concomitant Q waves in V1–V4, I, and aVL.

Figure 2. Coronary angiography. (A) Right coronary artery with 30% mild lesion in the proximal segment, blue arrow; (B) circumflex artery with no obstructive lesions; (C,D) left anterior descending (LAD) artery with 40% lesion in the middle segment, red arrows, with no evidence of thrombus and TIMI 3 flow. TIMI—Thrombolysis in myocardial infarction.

Figure 3. Optical coherence tomography of LAD. Cross-sectional images pre-PCI: (A) thin cap atheroma with an irregular luminal surface, suggestive of endothelial denudation (red arrow); (B) thin cap atheroma (red arrow) with abundant macrophages (blue circle); (C) plaque with a lipid arch greater than 180°; (D) cross-sectional image post-PCI at the smallest point displays an MLA of 7.41 mm2; (E) OCT post-PCI with lumen profile and rendered stent on the longitudinal OCT image using the tapered reference mode, with the point of smallest expansion being 105% of the desired expansion (in yellow). The OCT lumen profile shows the required total stent length of 60.2 mm (in blue). LAD—left anterior descending; PCI—percutaneous coronary intervention; MLA—minimum lumen area; OCT—optical coherence tomography.