Acute Coronary Syndrome With Persistent Thin-Cap Fibroatheroma Despite Intensive Lipid-Lowering Therapy　― Insights From Serial Optical Coherence Tomography ―

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  Figure.. (A) Initial target lesion where OCT revealed a layered plaque (red arrow, B), and also TCFA and a healed ruptured plaque (yellow arrow, C), which became the culprit lesion of acute coronary syndrome 7 months later. (B) Layered plaque at the culprit lesion. (C) TCFA (yellow arrows). (D) Improvement in stenosis after treatment with a drug-coated balloon. (E) Occlusion of the right coronary artery. (F) OCT after thrombus aspiration demonstrating no significant change in OCT-derived TCFA (yellow arrows), including fibrous cap thickness, at the same location as 7 months earlier. (G) Thrombosis (yellow arrow) and (H) improvement in coronary blood flow following implantation of a drug-eluting stent. OCT, optical coherence tomography; TCFA, thin-cap fibroatheroma.