Imaging-based demonstration of plaque regression and stabilization under inclisiran therapy using non-obstructive general angioscopy

Patients with a history of myocardial infarction (MI) remain at high risk for recurrent cardiovascular events, particularly when optimal lipid-lowering therapy cannot be sustained. A 74-year-old man with dyslipidaemia and a smoking history had an MI 2 years earlier and underwent primary percutaneous coronary intervention. During follow-up, statin therapy was discontinued due to hepatotoxicity, resulting in suboptimal lipid control. One year later, the patient presented with persistent chest discomfort, and coronary angiography confirmed no significant in-stent restenosis or obstructive lesions. Serial lipid profiling confirmed persistent LDL-C elevation (Upper panel). To assess systemic atherosclerotic activity, non-obstructive general angioscopy of the aorta was performed. Baseline angioscopy revealed widespread vulnerable plaques, including intense yellow plaque (yp), puff rupture (PR), puff-chandelier-like rupture (PCR), and ulcer (Middle left panels). Using vertebra-based aortic segmentation, unstable plaque features were assessed at each vertebral level, revealing unstable plaques in 10 of 12 levels (83%) (Lower panel; see Supplementary data online, Movie S1).