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Progression of Nonculprit Plaque Stenosis Following Successful Percutaneous Intervention

Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, bunch.thomas18{at}mayo.edu

Charanjit S. Rihal, MD

Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

Richard J. Gumina, MD, PhD

Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

Leslie Cooper, MD

Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

Noel M. Caplice, MD, PhD

Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

Despite percutaneous intervention after an acute coronary syndrome, patients remain at high risk for recurrent events in the first year. Prior studies have shown that a plaque rupture can occur not only at a single culprit lesion site but also in other atherosclerotic plaques throughout the coronary vasculature in patients with stable angina, silent myocardial ischemia, and during acute coronary syndromes. A 71-year-old man who presented with exertional angina and who had a successful stent in a culprit right coronary artery is described in this article. After 4 weeks, he represented with accelerated angina. A prior lesion in the obtuse marginal artery, remote from the site of the index lesion, had progressed from a 30% to 90% stenosis. This case report demonstrates the systemic nature of acute coronary syndromes, highlights the inherent instability of coronary artery disease, and supports the notion of aggressive secondary prevention in these patients.

Key Words: coronary arteriosclerosis • atherosclerosis • angioplasty • transluminal • percutaneous coronary • angina • unstable

This version was published on May 1, 2008

Angiology, Vol. 59, No. 2, 236-239 (2008)
DOI: 10.1177/0003319707306446


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