Impact of 1 month of intensive lipid-lowering therapy on plaque composition evaluated using near-infrared spectroscopy Open Access

A 46-year-old man was hospitalized due to acute coronary syndrome (ACS). Coronary angiography identified total occlusion of the left circumflex coronary artery (LCx) as the culprit lesion and severe stenosis in the proximal left anterior descending artery (LAD, arrowhead) (Panel A1). Near-infrared spectroscopy (NIRS) and intravascular ultrasound showed ultrasound attenuation with maximum lipid core burden index in a 4-mm segment (max-LCBI) of 701 in the LAD (Panels A2 and A3) and 760 in the LCx. Emergency percutaneous coronary intervention (PCI) was performed for the LCx culprit lesion, followed by intensive lipid-lowering therapy with pitavastatin (4 mg/day) and ezetimibe (10 mg/day). After 1 month of intensive lipid-lowering therapy, low-density lipoprotein cholesterol levels decreased from 139 mg/dL to 56 mg/dL. However, he complained of chest discomfort, so we decided to perform PCI for the LAD lesion. Near-infrared spectroscopy demonstrated a marked reduction in yellow signals (max-LCBI, 237; arrows) in the LAD, suggesting that the lipid-rich plaque had stabilized, whereas no significant changes were observed on coronary angiography (Panels B1–B3).

Near-infrared spectroscopy-intravascular ultrasound has been developed to assess the composition of atherosclerotic plaques and provides an automated quantitative assessment of lipid burden. Several studies have reported that NIRS-derived LCBI is associated with adverse clinical outcomes in patients with coronary artery disease. This case clearly demonstrated that many lipid-rich plaques might be present in non-culprit vessels that are not affected by ACS, as demonstrated with NIRS. One month of intensive lipid-lowering therapy with a statin and ezetimibe combination could stabilize plaque components.

Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.

Conflict of interest: None declared.