Plaque or no Plaque?

Excerpt

A 52 year old man with a history of hypercholesterolemia presented with an episode of chest pain on exertion. Cholesterol medications had been recommended to the patient in the past, but he had been noncompliant. EKG and cardiac enzymes were normal. The patient was referred for coronary CT angiography (CTA) to rule out coronary artery disease. A CT coronary angiogram (Fig. 1) was performed utilizing a GE LightSpeed VCT (GE^® Healthcare, Milwaukee, WI). Angiographic scan parameters: 12.5 cm spatial coverage in 5 s at a gantry rotation speed of 330 ms; tube voltage 120 kVp; tube current 600–700 mA; and collimation 64 × 0.625 mm. Based on the findings of a soft plaque on the cardiac CT, the patient was referred for cardiac catheterization (Fig. 1) to further assess the significance of this stenosis. The nonobstructive proximal LAD lesion was confirmed on invasive angiography and intravascular ultrasound (IVUS). While more aggressive risk factor modification is probably prudent in these patients with nonobstructive fatty plaques, there is no evidence-based data that the presence of non-calcified plaque as shown in the current case would justify more aggressive risk-factor modification, and further, current clinical guidelines do not recommend plaque imaging with CTA for screening purposes. However, our patient was started on intensive anti-hyperlipidemic therapy.

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