Figure 1.

Unstable plaque hide in heavily calcified coronary. Calcification in ruptured coronary plaques. Histologic and CCTA sections from a 65-year-old man who underwent CCTA exams prior to heart transplant surgery. Note large and irregular calcification (Ca++) with a large lipid core (core), combined with occlusive luminal thrombus. CCTA (right image) showed the presence of two features: a visual obvious calcification (in the shape of a diamond) accompanied by an annular-shape lower attenuation plaque tissue surrounding the lumen like a ring, we defined the DAS as a qualitative plaque feature in a mixed plaque on CCTA cross-section hiding in heavily calcified coronary. CCTA, coronary computed tomography angiography; DAS, diamond-attenuation-sign.