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

## TL;DR

A patient with a high-risk coronary plaque showed improvement after treatment with Evolocumab, a drug that helps stabilize dangerous plaques in the heart.

## Contribution

This case report demonstrates the potential of Evolocumab to stabilize vulnerable coronary plaques beyond LDL-C reduction.

## Key findings

- Evolocumab treatment led to a significant reduction in plaque volume and positive remodeling.
- The plaque transformed from a mixed to a calcified phenotype, indicating increased stability.
- LDL-C levels dropped dramatically, and the patient remained free of cardiovascular events for 24 months.

## 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.