Erupted coronary atheroma: insights from multi-modality imaging

A 58-year-old gentleman with prolonged chest pain and 20-min ST-segment elevation in inferior lead on Holter monitoring was hospitalized. Multi-slice computed tomography identified severe stenosis with low density area and positive remodeling. Despite the suggestive features of vulnerable lesion, intravascular ultrasound and near-infrared spectroscopy imaging identified ruptured plaque without any lipidic material which were contrary to findings from multi-slice computed tomography. Lipidic materials may travel into coronary circulation following its spontaneous rupture, resulting in zero lipid core burden index. Multi-modality imaging has the potential to elucidate the pathophysiology of eruption of coronary atheroma in vivo.