PMC6355420_01
Coronary angiography. (A) Total occlusion of the mid right coronary artery (arrow). (B) Total occlusion of the proximal left anterior descending coronary artery (arrow). (C) Post-stent deployment, with excellent results.
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CAG revealed occlusion of the proximal right coronary artery (RCA) and the proximal left anterior descending coronary artery (LAD) (Fig. 1A and B). Therefore, a 3.5x28-mm biolimus-eluting stent (BMX-J ; Terumo, Tokyo, Japan) and a 4.0x33-mm everolimus-eluting stent (Xience Alpine ; Abbott Vascular, Santa Clara, USA) were implanted in the RCA, generating excellent results on both angiography (Fig. 1C) and intravascular ultrasound (IVUS), without any stent edge dissection or incomplete dilatation.
Clinical courses of the LDL cholesterol concentration levels (upper panel) and detailed serial changes in the lipid parameters (lower panel). LDL: low-density lipoprotein
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Detailed serial changes in the lipid parameters are shown in Fig. 2.
DNA sequence data of exon 11 of LDLR gene. The arrowhead in the upper panel indicates the c.1655delT, p.I531TfsX15 mutation. (   ACACT   ) instead of the normal subject data (   ACATCT   ).
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Figs. 3 and 4 show the DNA sequence data of exon 11 of LDLR gene and exon 1 of PCSK9 gene, respectively.
DNA sequence data of exon 1 of the PCSK9 gene. The arrowhead indicates the c.10G>A, p.V4I mutation [GGGCACC(G/A)TCA] instead of the normal subject data (GGGCACCGTCA).
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Figs. 3 and 4 show the DNA sequence data of exon 11 of LDLR gene and exon 1 of PCSK9 gene, respectively.
(A) Intravascular ultrasound (IVUS) images (arrowhead site in Fig. 1C) immediately after PCI. (B) IVUS images (arrowhead site in Fig. 1C) immediately after PCI. The yellow zones indicate plaque. (C) IVUS images (arrowhead site in Fig. 1C) nine months after PCI. (D) IVUS images (arrowhead site in Fig. 1C) nine months after PCI. The yellow zones indicate plaque. PCI: percutaneous coronary intervention
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Terumo, at the follow-up phase) demonstrated that the percent atheroma volume (PAV) was decreased at 9 months (41.6%, Fig. 5D) compared with immediately after PCI (45.3%, Fig. 5B). The detailed measurement results are shown in Table. Aggressive LDL-C-lowering therapy with PCSK9 antibody plus rosuvastatin resulted in coronary plaque regression. The patient's other family members were not genotyped.