1. Detection of yellow plaque by near-infrared spectroscopy – Comparison with coronary angioscopy in a case of no-flow phenomenon during coronary intervention 
Yasunori Ueda, MD, PhD, FACC, FESC, FJCC, Koshi Matsuo, MD, Yuji Nishimoto, MD, Ryuta Sugihara, MD, Mayu Nishio, MD, PhD, Akio Hirata, MD, PhD, Mitsutoshi Asai, MD, PhD, Takayoshi Nemoto, MD, Ayaka Murakami, BS, Kazunori Kashiwase, MD, PhD, Masahiko Tsujimoto, MD, PhD, James E. Muller, MD, FACC, Kazuhisa Kodama, MD, PhD, FACC, FJCC 
Journal of Cardiology Cases 
Volume 9, Issue 5, Pages (May 2014)
DOI: /j.jccase
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

2. Fig. 1
Coronary angiogram of the right coronary artery. Coronary angiogram ((A) left anterior oblique view and (B) cranial view) revealed diffuse stenosis (red line with arrows) in the distal right coronary artery.
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

3. Fig. 2
Findings of near-infrared spectroscopy (NIRS). NIRS can detect lipid core plaque, which is presented as an yellow area in contrast to the normal area shown in red. The result of NIRS is presented as a red/yellow circle around the intravascular ultrasound image (A) or as a chemogram (B). The amount of lipid core plaque can be measured by lipid core burden index (LCBI), and the maximum LCBI of 4-mm segment (maxLCBI4mm) in this case was The distribution of yellow plaques detected by angioscopy appeared well correlated with the yellow areas with NIRS: two large plaques (2 and 4) were separated by relatively normal segment (3) in both examinations (see Fig. 3).
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

4. Fig. 3
Findings of angioscopy. Angioscopy revealed the presence of a ruptured yellow plaque with a thrombus in the target segment. The distribution of yellow plaques detected by angioscopy appeared well correlated with the yellow areas with near-infrared spectroscopy: two large plaques (2 and 4) were separated by relatively normal segment (3) in both examinations (see Fig. 2).
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

5. Fig. 4
Comparison between angioscopy and near-infrared spectroscopy (NIRS). Longitudinally, two large yellow plaques were separated by a very short normal segment both by angioscopy and NIRS. However, the presence of the thrombus could not be judged by NIRS as it does not have the algorithm to detect it. Because the circumferential image was not acquired by angioscopy, further detailed comparison of the images could not be performed.
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

6. Fig. 5
No-flow phenomenon after intervention. No-flow phenomenon was detected after balloon pre-dilatation (A) and was still observed after stent implantation (B). POBA, plain old balloon angioplasty.
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

7. Fig. 6
Coronary angiogram after the removal of filter. Coronary flow only partially recovered after the filter removal (A), which recovered in the final angiogram (B) after repeated injection of nicorandil in the protected vessel (yellow arrow) but was still disturbed in the non-protected vessel (red arrow).
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions

8. Fig. 7
The filter device removed from the coronary artery with no-flow phenomenon. (A) The filter was filled with much plaque debris, which caused filter no-flow but protected the vessel from real no-flow phenomenon in the vessel (yellow arrow in Fig. 6). (B) The captured material included the thrombus, foamy cells, cholesterol crystals, collagen fibers, and calcifications on histological examination.
Journal of Cardiology Cases 2014 9, DOI: ( /j.jccase )
Copyright © 2014 Japanese College of Cardiology Terms and Conditions