Coronary Computed Tomography Angiography for Observation of Stabilized Coronary Arterial Plaque after "Drug Intervention" : A Case Report

Abstract

A 54-year-old woman with unstable angina underwent coronary stent deployment. She was started on rosuvastatin therapy before undergoing percutaneous coronary intervention (PCI). However, arriving at low-density lipoprotein cholesterol (LDL-C) levels lower than 70 mg/dL required more than a month of treatment. This was accomplished by increasing the rosuvastatin dose by 10 mg and adding ezetimibe. Chronic-phase coronary computed tomography angiography (CCTA) did not show stent restenosis but revealed plaque progression in the left main trunk (LMT). A combination of rosuvastatin, ezetimibe, and the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor was administered to promote regression of the plaque. Follow-up CCTA performed 12 months after the initial scan showed regression of the LMT plaque and the appearance of new calcification in the proximal plaque of the left anterior descending (LAD) artery. The aggressive lipid-lowering strategy that combined rosuvastatin, ezetimibe, and a PCSK9 inhibitor successfully achieved plaque regression without the occurrence of cardiovascular events.