Hyper-echoic plaque with high attenuation in intravascular ultrasound may predict slow flow during percutaneous coronary intervention.

One patient with acute inferior wall myocardial infarction underwent percutaneous coronary intervention following intravenous thrombolysis. Intravascular ultrasound (IVUS) before stenting revealed huge plaque burden with high attenuation underneath the hyper-echoic eccentric plaque surface. Stent deployment resulted in slow flow, which was managed with intra-aortic balloon counter-pulsation. His another lession in the mid left anterior descending artery showing eccentric hypo-echoic plaque with neither hyper-echoic surface nor high attenuation was successfully stented without causing slow flow.