Lipid-Rich Plaque Beneath Dense Calcium: Imaging-Guided Lithotripsy in Calcified Double-Vessel Disease.
- 1Department of Allied and Healthcare Sciences, Jamia Hamdard, New Delhi, India.
- 2Innovative Therapeutic Pvt. Ltd., Chennai, Tamil Nadu, India.
- 3Department of Allied and Healthcare Sciences, Jamia Hamdard, New Delhi, India. Electronic address: [email protected].
Abstract
Background
Grayscale intravascular ultrasound grades coronary calcium but cannot detect lipid sequestered behind a calcific plate because both attenuate the ultrasound signal.Case summary
A 56-year-old man with palpitations and exertional chest discomfort had double-vessel disease: a critical proximal left anterior descending (LAD) stenosis and a severe mid-to-distal right coronary artery (RCA) lesion. Coregistered near-infrared spectroscopy and intravascular ultrasound showed near-circumferential calcium in both vessels, with a large lipid core hidden beneath the LAD calcific shell (maximum lipid core burden index over 4 mm: 788) and a lipid-poor RCA focus (maximum lipid core burden index over 4 mm: 249). Lithotripsy and drug-eluting stents were used in both vessels. The lipid-rich LAD expanded well; the lipid-poor RCA focus did not.Take-home message
Plaque chemistry, not calcium geometry alone, may explain why some calcified segments resist lithotripsy.
Related
- Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis
- Treatment of Calcified Peripheral Artery Disease With the Shockwave Forward Peripheral Intravascular Lithotripsy System: One-Year Outcomes From the FORWARD PAD IDE and Mini S Feasibility Studies
- Shockwave Lithotripsy for Severe Calcified Extracranial Vertebral and Carotid Disease Treated With Percutaneous Stenting
- Intravascular lithotripsy for highly calcified carotid stenoses: distal (filter) protection may not suffice
- Calcium-Modification Techniques in Calcified Coronary Artery Disease: A Systematic Review of Comparative Evidence on Procedural Success, Complications and Clinical Outcomes
BibTeX
@article{raza2026lipidrich,
title = {{Lipid-Rich Plaque Beneath Dense Calcium: Imaging-Guided Lithotripsy in Calcified Double-Vessel Disease.}},
author = {Syed Nazar Raza and Md Rehan Akhtar and Manav Jyala and Syed Abeera Andrabi},
journal = {JACC. Case reports},
year = {2026},
month = oct,
doi = {10.1016/j.jaccas.2026.110264},
url = {https://europepmc.org/article/MED/42847579},
note = {CC BY},
}
RIS
TY - JOUR
TI - Lipid-Rich Plaque Beneath Dense Calcium: Imaging-Guided Lithotripsy in Calcified Double-Vessel Disease.
AU - Syed Nazar Raza
AU - Md Rehan Akhtar
AU - Manav Jyala
AU - Syed Abeera Andrabi
PY - 2026
DA - 2026/10/01
JO - JACC. Case reports
DO - 10.1016/j.jaccas.2026.110264
UR - https://europepmc.org/article/MED/42847579
AB - Background Grayscale intravascular ultrasound grades coronary calcium but cannot detect lipid sequestered behind a calcific plate because both attenuate the ultrasound signal.Case summary A 56-year-old man with palpitations and exertional chest discomfort had double-vessel disease: a critical proximal left anterior descending (LAD) stenosis and a severe mid-to-distal right coronary artery (RCA) lesion. Coregistered near-infrared spectroscopy and intravascular ultrasound showed near-circumferential calcium in both vessels, with a large lipid core hidden beneath the LAD calcific shell (maximum lipid core burden index over 4 mm: 788) and a lipid-poor RCA focus (maximum lipid core burden index over 4 mm: 249). Lithotripsy and drug-eluting stents were used in both vessels. The lipid-rich LAD expanded well; the lipid-poor RCA focus did not.Take-home message Plaque chemistry, not calcium geometry alone, may explain why some calcified segments resist lithotripsy.
SN - 2666-0849
ER -