Coronary computed tomography angiography (CCTA) has evolved notably over the last decade, gaining an increased amount of temporo-spatial resolution in combination with decreased radiation exposure. The importance of CCTA is emerging especially in vulnerable and young patients who might not have developed a viable collateral vascular network to sustain the circulation to an infarction area during a major adverse coronary event. There are a few well-known markers by which a vulnerable plaque can be assessed and that can predict the subsequent events of sudden myocardial ischemia, such as an increased positive remodeling index (cut-off >1.4), low-attenuation plaque (cut-off <30 HU), plaque burden (cut-off >0.7), and napkin-ring sign (NRS). This manuscript presents a series of 3 clinical cases of young patients experiencing symptoms and signs of myocardial ischemia who underwent CCTA in order to assess the composition and functional characteristics of atherosclerotic plaques and their repercussion in developing an acute coronary syndrome.
2. Opolski MP, Kępka C, Rużyłło W. Computed tomography for detection of vulnerable coronary plaque – A Cassandra’s dream? Postępy w Kardiologii Interwencyjnej/Advances in Interventional Cardiology. 2014;10:147-152.
3. Choy SY, Mintz GS. What have we learned about plaque rupture in acute coronary syndromes? Curr Cardiol Rep. 2010;12:338-343.
4. Lafont A. Basic aspects of plaque vulnerability. Heart. 2003;89:1262-1267.
5. Batty JA, Subba S, Luke P, Gigi LWC, Sinclair H, Kunadian V. Intracoronary imaging in the detection of vulnerable plaques. Curr Cardiol Rep. 2016;18:28.
6. Motoyama S, Masayoshi S, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol. 2009;54:49-57.
7. Maurovich-Horvat P, Schlett CL, Alkadhi H, et al. The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging. 2012;5:1243-1252.
8. Benedek T, Gyöngyösi M, Benedek I. Multislice computed tomographic coronary angiography for quantitative assessment of culprit lesions in acute coronary syndromes. Can J Cardiol. 2013;29:364-371.
9. Pontone G, Andreini D, Bartorelli AL, et al. Radiation dose and diagnostic accuracy of multidetector computed tomography for the detection of significant coronary artery stenoses: a meta-analysis. Int J Cardiol. 2012;160:155-164.
10. Goldstein JA, Chinnaiyan KM, Abidov A, et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) Trial. J Am Coll Cardiol. 2011;58:1414-1422.
11. Stone GW, Maehara A, Lansky AJ, et al. A Prospective Natural History Study of Coronary Atheroscelrosis. N Engl J Med. 2011;364:226-235.
12. Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow up. JACC. 2015;337-46.