Long IVUS-attenuated plaque without no-reflow: histological findings of captured embolic debris and implications for the interpretation of IVUS attenuation: a case report
Abstract
Background: The no-reflow phenomenon during percutaneous coronary intervention (PCI) is commonly associated with distal embolization from high-risk coronary plaques, including lesions with intravascular ultrasound (IVUS)-defined attenuation. Histopathological analysis of embolic debris captured during PCI is rarely reported and may provide additional insights into the relationship between plaque characteristics and coronary flow outcomes.
Case summary: An 84-year-old man presented with acute coronary syndrome and decompensated heart failure. Coronary angiography demonstrated severe multi-vessel coronary artery disease, including a long right coronary artery lesion with extensive IVUS attenuation. Given the high risk of distal embolization, PCI was performed using a distal protection device. Drug-eluting stents were successfully implanted, and Thrombolysis In Myocardial Infarction flow grade 3 was maintained throughout the procedure without slow flow or no reflow. Histopathological examination of debris captured by the distal protection device demonstrated predominantly fibrin- and collagen-rich thrombotic material with macrophage infiltration and no apparent abundant lipid component. The patient experienced an uneventful recovery and was discharged without procedural complications.
Discussion: The composition of retrieved embolic debris captured during PCI differed from the expected imaging phenotype. This case highlights the potential discrepancy between intracoronary imaging appearance and embolized material and underscores the multifactorial nature of coronary slow flow and no reflow. Careful interpretation of IVUS attenuation and embolic pathology is warranted when assessing procedural risk.
Related
- Tartrazine-Induced Toxicity Is Attenuated by Naringenin in Wistar Rats: A Biochemical, Histological, and Behavioral Study
- Limited tissue persistence confirms attenuation of live-attenuated chikungunya vaccine VLA1553 in non-human primates.
- The clinical course of nasal polyps in relation with histological and radiological findings
- Histological control data in target and non-target organs versus induced findings from 74 amphibian metamorphosis assays (AMAs) using the African clawed frog (Xenopus laevis)
- Ribociclib-Induced Vitiligo: A Case Report with Histological, Dermatoscopic, Confocal Microscopy, and LC-OCT Findings Along with a Narrative Literature Review.
BibTeX
@article{suzuki2026long,
title = {{Long IVUS-attenuated plaque without no-reflow: histological findings of captured embolic debris and implications for the interpretation of IVUS attenuation: a case report}},
author = {Kenta Suzuki and Tomomi Koizumi and Yukinori Inadome},
journal = {European Heart Journal. Case Reports},
year = {2026},
month = oct,
doi = {10.1093/ehjcr/ytag739},
url = {https://doi.org/10.1093/ehjcr/ytag739},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Long IVUS-attenuated plaque without no-reflow: histological findings of captured embolic debris and implications for the interpretation of IVUS attenuation: a case report
AU - Kenta Suzuki
AU - Tomomi Koizumi
AU - Yukinori Inadome
PY - 2026
DA - 2026/10/08
JO - European Heart Journal. Case Reports
DO - 10.1093/ehjcr/ytag739
UR - https://doi.org/10.1093/ehjcr/ytag739
AB - Background: The no-reflow phenomenon during percutaneous coronary intervention (PCI) is commonly associated with distal embolization from high-risk coronary plaques, including lesions with intravascular ultrasound (IVUS)-defined attenuation. Histopathological analysis of embolic debris captured during PCI is rarely reported and may provide additional insights into the relationship between plaque characteristics and coronary flow outcomes. Case summary: An 84-year-old man presented with acute coronary syndrome and decompensated heart failure. Coronary angiography demonstrated severe multi-vessel coronary artery disease, including a long right coronary artery lesion with extensive IVUS attenuation. Given the high risk of distal embolization, PCI was performed using a distal protection device. Drug-eluting stents were successfully implanted, and Thrombolysis In Myocardial Infarction flow grade 3 was maintained throughout the procedure without slow flow or no reflow. Histopathological examination of debris captured by the distal protection device demonstrated predominantly fibrin- and collagen-rich thrombotic material with macrophage infiltration and no apparent abundant lipid component. The patient experienced an uneventful recovery and was discharged without procedural complications. Discussion: The composition of retrieved embolic debris captured during PCI differed from the expected imaging phenotype. This case highlights the potential discrepancy between intracoronary imaging appearance and embolized material and underscores the multifactorial nature of coronary slow flow and no reflow. Careful interpretation of IVUS attenuation and embolic pathology is warranted when assessing procedural risk.
SN - 2514-2119
ER -