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Lipid-Rich Plaque Masquerading as a Coronary Thrombus

Shereif H. Rezkalla, MD, Department of Cardiology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449
David R. Holmes Jr, MD, Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905

Reprint Requests: Shereif H. Rezkalla, MD, Cardiovascular Research, Department of Cardiology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, Tel.: 715-387-5845, Fax: 715-389-3808, Email: rezkalla.shereif{at}marshfieldclinic.org

A 43-year-old woman presented with exertional chest pressure. Right coronary angiography showed a clear filling defect. Intravascular ultrasound revealed a plaque with 80% stenosis and a large lipid pool. Therefore, a stent was placed, and the patient became angina-free. Lipid-rich plaques are a cause of angiographic filling defects. Intravascular ultrasound is an integral part of coronary artery evaluation.

Key Words: Coronary calcification • Intravascular ultrasound • Lipid plaques and filling defects • Percutaneous coronary intervention