Ewha Med J.  2012 Mar;35(1):65-68. 10.12771/emj.2012.35.1.65.

Severe Negative Remodeling at the Middle Right Coronary Artery without Atheroma Plaque

• Chang KY
• Park KS
• Choi YA
• Kim JH
• Jeon BS
• Her SH

• KMID: 2134950
• DOI: http://doi.org/10.12771/emj.2012.35.1.65

Abstract

Arterial remodeling is commonly observed in human atherosclerosis. It is a heterogeneous response ranging from positive remodeling to negative remodeling. Negative remodeling is a condition in which the vessel area decreases in size, often as a result of a structural change in the coronary vessel wall. But its contribution to myocardial ischemia in a de novo lesion has not been clearly shown. A 51-year-old female with exertional angina was admitted to our hospital. Coronary angiography was performed, revealing a severe stenosis at the middle part of the right coronary artery (RCA). Although we predilated ballooning at the middle RCA, the degree of stenosis did not improve. Thus intravascular ultrasound (IVUS) was performed. The lesion was not nearly showed plaque burden and severe negative remodeling. Though the cross-sectional narrowing percentage was significant, we decided to medical treatment for fearing coronary perforation by stenting. This case report intends to emphasize that severe coronary stenosis should be performed IVUS before the stenting. We describe a rare case with severe negative remodeling at the middle part of the RCA without atheroma plaque.

Keyword

Angina; Atherosclerosis; Ultrasound, intravascular; Negative remodeling

MeSH Terms

Atherosclerosis
Constriction, Pathologic
Coronary Angiography
Coronary Stenosis
Coronary Vessels
Female
Glycosaminoglycans
Humans
Myocardial Ischemia
Plaque, Atherosclerotic
Stents
Glycosaminoglycans

Figure

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  Fig. 1 Exercise treadmill test was positive by typical angina at 4.6 METs.

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  Fig. 2 Right coronary angiogram revealed a severe stenosis at the middle part of the right coronary artery (arrow).

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  Fig. 3 Intravascular ultrasound was showed severe negative remodeling (B) without atheroma plaque compared to the proximal and distal site (A, C).

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