Muñoz Pousa Isabel, Hernández Ubaldo, Jiménez Díaz Victor A
Department of Cardiology, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor, 341, 36212 Vigo, Pontevedra, Spain.
Eur Heart J Case Rep. 2021 May 31;5(6):ytab128. doi: 10.1093/ehjcr/ytab128. eCollection 2021 Jun.
Intracoronary imaging techniques have allowed characterizing atherosclerotic plaques morphologically in patients with the acute coronary syndrome (ACS). Although the main feature described is plaque rupture, the use of optical coherence tomography has made it possible to objectify that the eroded plaque is not uncommon in this setting.
We presented a case of a 45-year-old man with active smoking and cocaine user, admitted to the emergency department for chest pain. The electrocardiogram showed ST-segment elevation myocardial infarction (STEMI) in the inferior leads. Emergent coronary angiography was performed, showing thrombotic occlusion of mid-distal right coronary artery. After successful thromboaspiration, no areas of significant angiographic stenosis were observed. Optical coherence tomography imaging at the occlusion site revealed an eroded plaque and a remaining small thrombusburden. Conservative management without stent implantation was decided. Treatments consisted of an acute phase glycoprotein IIb/IIIa inhibitor and subsequently dual antiplatelet therapy with Aspirin (ASA) and Ticagrelor 90 mg b.i.d. for 12 months. The patient remains asymptomatic and uneventful at 9-month follow-up.
Young age, history of active smoking, and cocaine use are common clinical features in patients with ACS due to an eroded plaque. These patients frequently display a STEMI with the involvement of a single coronary vessel. Optical coherence tomography imaging aids to a precise diagnosis and to define a proper treatment.
冠状动脉内成像技术已能够对急性冠状动脉综合征（ACS）患者的动脉粥样硬化斑块进行形态学特征分析。尽管所描述的主要特征是斑块破裂，但光学相干断层扫描的应用已使客观证实糜烂斑块在这种情况下并不罕见成为可能。
我们报告了一例45岁男性患者，有主动吸烟史且使用可卡因，因胸痛入住急诊科。心电图显示下壁导联ST段抬高型心肌梗死（STEMI）。进行了急诊冠状动脉造影，显示右冠状动脉中远端血栓性闭塞。成功进行血栓抽吸后，未观察到明显的血管造影狭窄区域。闭塞部位的光学相干断层扫描成像显示为糜烂斑块和残留的少量血栓负荷。决定采取不植入支架的保守治疗。治疗包括急性期糖蛋白IIb/IIIa抑制剂，随后使用阿司匹林（ASA）和替格瑞洛90毫克每日两次进行双联抗血小板治疗，持续12个月。患者在9个月随访时仍无症状且病情平稳。
年轻、主动吸烟史和使用可卡因是因糜烂斑块导致ACS患者的常见临床特征。这些患者常表现为单支冠状动脉受累的STEMI。光学相干断层扫描成像有助于精确诊断并确定恰当的治疗方案。
