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No reflow phenomenon during percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) has an unfavorable outcome. Previously, some investigators have tried to determine the predictors of this phenomenon, but there are still controversies as to whether it is possible to make predictions beforehand. Here we report the first clinical case by intravascular ultrasound (IVUS) with a newly designed pattern recognition algorithm to evaluate the tissue characteristics of the culprit lesion in a 64-year-old patient with ACS who suffered from no reflow phenomenon during PCI. We also reveal the plaque composition of the culprit lesion of another ACS patient without no reflow as well as a stable angina pectoris patient. The percentage of necrotic tissue was higher in the culprit lesion in a patient with no reflow than in the others. In conclusion, a new spectral similarity concept of IVUS is promising in differentiating ambiguous tissue characterization results.

New Modality for Evaluating Plaque Characteristics of the Culprit Lesion in a Patient With Acute Coronary Syndrome and No Reflow Phenomenon