Key result
IVUS accurately identifies an ambiguous coronary lesion as layered plaque rather than SCAD.
Why the study?
Diagnosing ambiguous culprit lesions by coronary angiography is challenging, particularly in the presence of vessel overlap, tortuosity, or eccentric lesions.
Case Report (n=1)
Intravascular ultrasound is valuable for accurately characterizing ambiguous coronary lesions, such as distinguishing layered plaque from spontaneous coronary artery dissection when angiography is inconclusive.
IVUS may differentiate layered plaque from SCAD when angiography is inconclusive; single case report leaves open need for validation.
Diagnosing ambiguous culprit lesions by coronary angiography is challenging, particularly in the presence of vessel overlap, tortuosity, or eccentric lesions. In such cases, intravascular imaging provides critical diagnostic insights. We present the case of a 55-year-old female with recurrent chest pain, initially suspected to have spontaneous coronary artery dissection (SCAD) based on clinical context. Coronary angiography was inconclusive; however, intravascular ultrasound (IVUS) revealed distinct plaque layers with varying echogenicity separated by clear borders-findings more consistent with a layered plaque than SCAD. This case highlights the value of intravascular imaging in accurately characterizing ambiguous coronary lesions and guiding appropriate management.
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Suwa et al. (2025) conducted a case report in Ambiguous coronary lesion / suspected SCAD (n=1). Intravascular ultrasound (IVUS) vs. Coronary angiography was evaluated. Intravascular ultrasound accurately characterized an ambiguous coronary lesion as a layered plaque rather than spontaneous coronary artery dissection in a 55-year-old female.
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