Work

Vasospasm-Associated Plaque Erosion

Year: 2025

Type: article

Abstract: BACKGROUND: Plaque erosion is a significant cause of acute coronary syndromes, representing a distinct pathophysiological entity from plaque rupture. Coronary vasospasm is a suspected trigger for erosion, though its precise mechanisms are not fully understood. Furthermore, reports of its histopathological confirmation by directional coronary atherectomy (DCA) are limited. CASE PRESENTATION: We present the case of a 56-year-old male with organic coronary stenosis and a clinical history suggestive of vasospasm. Intravascular optical coherence tomography revealed features highly suggestive of plaque erosion, including an overlying white thrombus. To obtain a definitive diagnosis, DCA was performed for tissue acquisition. Subsequent histopathological examination of the retrieved specimens clearly confirmed plaque erosion, demonstrating a thrombus adherent to an intact, smooth muscle cell-rich intimal layer without disruption of a fibrous cap. CONCLUSIONS: This case provides DCA-confirmed pathological evidence for the clinically important potential link between coronary vasospasm and plaque erosion.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105367