本症例の冠動脈径は小さいが、IVUSで不安定性プラークが証明できた貴重な症例であり、胸部症状の原因として強く考えられる。有症状の冠動脈解離が認められている症例およびPCIによって冠動脈外傷や冠動脈解離の形成が危惧される症例は、冠動脈造影画像上正常に見えてもIVUS上、不安定プラークや血栓を伴う病変が認められ可能性もあり、冠動脈解離の新規発症やフォローおよび、血栓の有無、プラークの安定性を評価し、慎重なマネジメントが求められる。
In this case, the coronary artery is small, but the IVUS has proven that the unstable plaque has formed, making this the likely cause of the chest pains. For this condition, coronary artery dissection is an approved treatment, and PCI, but should that cause trauma to the coronary artery and danger to the patient, imaging of the coronary artery, such as IVUS, should follow the dissection to monitor for the possibility of new occurrences of unstable plaque and lesions which could cause blood clots. Careful management is required to assess for the existence of blood clots and to monitor whether the plaque should become unstable.
