High-Risk Plaque Regression and Stabilization

Coronary computed tomography angiography (CCTA) holds a prime role in noninvasive assessment of atherosclerosis by enabling plaque characterization and serial imaging. The napkin-ring sign has been described in plaques that are characterized at CCTA by a low attenuation center, covered by a higher attenuation ring-like periphery. Such atherosclerotic plaques are closely linked with future acute coronary syndromes, independent of other high-risk CCTA plaque features, such as low attenuation plaque and positive remodeling.1 Medical treatment, primarily with the use of statins, that promote plaque stabilization, has been associated with resolution of inflammation and favorable histological changes in coronary plaques, leading to plaque regression.2We present a 62-year-old male patient with history of hypertension and dyslipidemia who was assessed with CCTA because of atypical chest pain (Figure 1). A high-risk coronary plaque was identified at the mid left anterior descending artery (LAD) resulting in moderate luminal stenosis (≈50%; Figure 1, left). The upstream/proximal (Figure 1i, …