Angioscopic Findings of Neovascularization Around Yellow Plaque

A 25-year-old male patient with acute myocardial infarction underwent emergency coronary angiography (CAG), which showed occlusion in the left anterior descending artery (LAD) (Figure A). Although recanalization was achieved after thrombectomy and plain old balloon angioplasty (POBA), intravascular ultrasound demonstrated a large amount of thrombus with no significant atheromatous stenosis (Figure B). Expecting thrombus dissolution, we decided to use intra-aortic balloon pumping (IABP) without stent placement and the patient received anticoagulation drugs and aspirin with heparinization. At 1 week after the coronary intervention, we performed CAG, which demonstrated slight stenosis in the mid-LAD but no intracoronary thrombus (Figure C). The angioscopic image revealed yellow plaque with a red network structure of capillaries (Figure D,E) and a proximal lesion, an ulcer-like lesion with a red blood clot, which was regarded as the culprit lesion (Figure F). These imaging findings were equivalent to histological evidence of neovascularization in atherosclerosis. According to a hypothesis based on histological observation, adventitia-derived vasa vasorum neovascularization develops under intima containing lipoprotein deposits. Macrophages are attracted by extravasation of red blood cells from leaky neovessels. Plaque rupture and thrombosis are precipitated by macrophage-derived matrix metalloproteinase secretion.¹

Figure.

(A) Baseline coronary angiography (CAG). (B, Supplementary Movie) Intravascular ultrasound showing a large thrombus without significant stenosis. (C) CAG at 1 week after coronary intervention. (D–F) Angioscopic images from distal to proximal of the area indicated by the yellow arrow in (c), showing yellow plaque with a red network structure of capillaries (D,E) and an ulcer-like lesion with a red blood clot, which was regarded as the culprit lesion (F).

Disclosures

Y.S. is a member of Circulation Journal’s Editorial Team.

IRB Information

The present study was approved by the Ethics Committee of Nishinomiya Municipal Central Hospital (reference no. 617)

Supplementary Files

Supplementary Movie.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-21-0102

Reference

• 1.   Moreno PR, Purushothaman KR, Sirol M, Levy AP, Fuster V. Contemporary reviews in cardiovascular medicine: Neovascularization in human atherosclerosis. Circulation 2006; 113: 2245–2252.