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Case Reports
. 2025 Feb 14;14(4):1257.
doi: 10.3390/jcm14041257.

Patient with Vulnerable Coronary Plaque and Treatment with Evolocumab: A Clinical Case

Lucio Addeo  1 , Pasquale Guarini  2 , Pasquale Campana  3 , Luigi Argenziano  3 , Stefano Nardi  3 , Carlo Tedeschi  4 , Alessandra Scatteia  5 , Mattia Silvestre  6 , Antonio Rapacciuolo  1 , Giovanni Esposito  1 , Salvatore Giordano  7 , Laura Adelaide Dalla Vecchia  8 , Francesco Donatelli  9
Affiliations
Case Reports

Patient with Vulnerable Coronary Plaque and Treatment with Evolocumab: A Clinical Case

Lucio Addeo et al. J Clin Med. .

Abstract

Background/Objectives: Vulnerable coronary plaques are strongly associated with acute coronary events, posing significant therapeutic challenges despite statin therapy. This case report evaluates the impact of Evolocumab, a PCSK-9 inhibitor, on stabilizing high-risk plaques and promoting phenotypic transformation, assessed through coronary CT angiography (CCTA). Methods: A 50-year-old male with chronic coronary syndrome and a history of myocardial infarction underwent a CCTA, revealing a high-risk plaque (approximately 50%) in the proximal LAD. Despite achieving LDL-C targets with statin therapy, the plaque showed vulnerability features. Evolocumab (140 mg subcutaneously every two weeks) was added to therapy, combined with dietary counseling and dual antiplatelet therapy. Results: A follow-up CCTA at 24 months demonstrated significant reductions in plaque volume and positive remodeling, with a transformation from a mixed phenotype to a predominantly calcified plaque. LDL-C levels decreased from 71 mg/dL to 18 mg/dL. The patient remained asymptomatic, with no cardiovascular events reported during the follow-up. Conclusions: This case highlights the role of PCSK-9 inhibitors in stabilizing high-risk plaques, achieving structural changes that promote stability beyond LDL-C reduction. Advanced imaging techniques such as CCTA proved essential for risk stratification and monitoring therapy efficacy. Evolocumab offers a promising adjunctive treatment for high-risk patients unsuitable for elective revascularization, potentially redefining the standard of care for plaque stabilization in this setting.

Keywords: PCSK-9 inhibitors; coronary CT angiography; plaque stabilization.

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Conflict of interest statement

The authors report no conflicts of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
CCTA reveals a high-risk mixed plaque in the proximal LAD with a predominantly non-calcified component (left). After Evolocumab therapy, the plaque transforms into a more calcified, stable phenotype with reduced volume (right).
Figure 2
Figure 2
LDL-C values post-PCI and during follow-up.
See this image and copyright information in PMC

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