PCCT and IVUS-NIRS for High-Risk Plaque Management.

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-22 DOI:10.1016/j.jaccas.2026.110536

Chinh Duc Nguyen, Dinh Cong Pham, Huong Thi Quynh Tran, Anh Duong Quoc Nguyen, Thai Quang Trieu, Dung Thuong Ho, Cuong Chi Tran

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Abstract

Background: High-risk coronary plaque may be underrecognized in patients with atypical symptoms and negative biomarkers. Advanced coronary imaging can add anatomical and prognostic information.

Case summary: A 59-year-old woman presented with acute chest pain, mild ischemic electrocardiographic changes, and negative high-sensitivity troponin. Photon-counting computed tomography (PCCT) showed a predominantly noncalcified, lipid-rich-appearing plaque in the left anterior descending artery despite a low risk profile. Angiography confirmed significant stenosis, and intravascular ultrasound with near-infrared spectroscopy (NIRS) demonstrated a high-risk plaque phenotype with maximum lipid core burden index over 4 mm of 347. Percutaneous coronary intervention used distal drug-coated balloon treatment and proximal-to-mid drug-eluting stent implantation. Postprocedural imaging confirmed adequate stent expansion and lower NIRS lipid signal.

Discussion: This case highlights the complementary role of PCCT and intravascular imaging for identifying and managing vulnerable coronary plaque.

Take-home message: PCCT for noninvasive plaque characterization and intravascular ultrasound-NIRS for intraprocedural guidance provide a complementary strategy for personalized management of vulnerable coronary plaque.

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PCCT和IVUS-NIRS用于高危斑块管理。

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