Healed coronary plaque rupture as a cause of rapid lesion progression: a case demonstrated with in vivo histopathology by directional coronary atherectomy
Tsuchiya H, Nakano A, Nakamura N et al.

KEYWORDS
healed coronary plaque rupture; lesion progression; directional coronary atherectomy

Coronary plaque rupture is a culprit lesion morphology of thrombotic events leading to acute coronary syndrome (ACS). Meanwhile, coronary plaque rupture often occurs silently and heals spontaneously. This phenomenon is recognized as healed plaque rupture (HPR) in pathological studies. HPR is considered to be a cause of lesion progression, although most reports have been based on ex vivo autopsy specimens, therefore HPR remains underappreciated.

A 75-year-old man with a history of previous percutaneous coronary intervention to the left circumflex artery was admitted with recurrent ACS. Coronary angiography revealed rapid progressive lesion in the right coronary artery, where only mild stenosis existed 4 months prior (Panels A and...