Unruptured Thin-Cap Fibroatheroma with Overlying Platelet-Rich Thrombus in Left Main Coronary Artery- A Previously Unreported Culprit Lesion in Acute Coronary Syndrome

 Unruptured Thin-Cap Fibroatheroma with Overlying Platelet-Rich Thrombus in Left Main Coronary Artery – A Previously Unreported Culprit Lesion in Acute Coronary Syndrome

In patients undergoing coronary angiography, thin-cap fibroatheroma are reported to be extremely rare in the left main coronary artery and, that too only as non-culprit lesions in patients with acute coronary syndrome. We report on a patient presenting with acute coronary syndrome and with angiographically documented isolated left main coronary artery disease as the culprit lesion. With optical coherence tomography imaging, we were able to demonstrate the presence of thin-cap fibroatheroma with overlying intraluminal white thrombus. The cap of the atheromatous lesion was unruptured. This phenomenon of unruptured thin-cap fibroatheroma in the left main coronary artery presenting as the culprit lesion in acute coronary syndrome has not been reported previously.