Serial Assessment of Pericoronary Adipose Tissue Inflammation in a Patient With MINOCA Potentially Complicated With Vasospasm

Figures

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  Figure 1. Serial coronary angiogram (upper panel) and optical coherence tomography images (lower panel). (A) Initial coronary angiography (CAG) revealed mild stenosis (dashed line) in the left anterior descending (LAD) coronary artery. Optical coherence tomography (OCT) revealed intracoronary thrombus (arrow) overlying a fibrous plaque with an intact fibrous cap, which was suggestive of OCT-defined plaque erosion as the culprit plaque phenotype. The minimal lumen area was preserved (5.12 mm2). (B) On the acetylcholine provocation test, subtotal stenosis was provoked after intracoronary administration of 100 μg of acetylcholine into the left coronary artery. OCT showed reduction of the thrombus volume in the proximal LAD coronary artery. (C) Follow-up CAG confirmed no significant progression of stenosis in the LAD coronary artery. OCT exhibited formation of a layered plaque.

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  Figure 2. Analysis of pericoronary inflammation by coronary computed tomography angiography (CTA). Pericoronary adipose tissue attenuation (PCATA), defined as the mean computed tomography attenuation value of the pericoronary adipose tissue within a radial distance equal to the reference diameter of the vessel along the segments (40 mm in length), was evaluated. (A) Coronary CTA on admission showed PCATA of –62.04 Hounsfield units (HU). (B) Coronary CTA performed 2 years later showed PCATA of –77.16 HU.