Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: Analysis by intravascular ultrasound

Ischemia and No Obstructive Coronary Artery Disease (INOCA)

“…Considerable evidence now documents that this syndrome is associated with a prognosis that is clearly not benign, yet no clinical practice management guidelines exist for these patients. While there is likely overlap between INOCA and myocardial infarction with no obstructive coronary arteries (MINOCA) which appears to be increasingly described 5–7 , the primary need and focus is on non-MI syndromes. To summarize current knowledge and provide next steps for developing evidence-based management strategies for INOCA, a “Think Tank” was convened at the American College of Cardiology (ACC) Heart House, Washington D.C., May 17, 2016.…”

“…64 Plaque rupture by IVUS was not observed in INOCA patients from two series of patients with chronic angina. 5, 22, 64 Two single-center reports of non-obstructive CAD presenting with ACS suggest that plaque rupture is observed in the minority: 38% of 50 women 6 and 37% of men and women. 5 The former study found that plaque ulceration was also frequent, in addition to late gadolinium enhancement with an ischemic pattern of injury.…”

Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It's Time to Face Reality!

“…When needed and if resources permit, additional testing should be considered, including intracoronary imaging studies with intravascular ultrasound or optical coherence tomography, thrombophilia testing, provocative testing for coronary vasospasm, and cardiac magnetic resonance imaging. Studies of intracoronary imaging have shown that ≈40% of patients with MINOCA have some evidence of plaque disruption 16, 17. Although intravascular ultrasound is helpful in demonstrating plaque rupture,16 Optical coherence tomography is a better tool for identifying patients with plaque erosion18 and may be superior for the assessment of patients with spontaneous coronary artery dissection 19.…”

Some peculiarities of acute myocardial infarction pathogenesis in non-obstructive coronary arteries

“…These cases include erosion, ulceration of plaques, hemorrhages. The studies conducted using intravascular ultrasound imaging method showed that, according to CA data, in 40 % cases of MI with non-obstructive lesions in coronary arteries the above morphological changes of atherosclerotic plaque in infarction-related artery are revealed [12,14]. In addition, cases have been described involving calcified tectum thrombosis of atherosclerotic plaque without disruption of its continuity and without obstruction of artery lumen [7].…”