ATHEROSCLEROTIC PLAQUE HEMORRHAGE AND RUPTURE ASSOCIATED WITH CRESCENDO CLAUDICATION

Atherosclerotic plaque rupture with intraluminal thrombus formation has not been previously described in patients with peripheral vascular disease who have accelerated symptoms of claudication. We describe a patient in whom claudication progressed from the occurrence of symptoms only after 100 yards of level walking to the occurrence of symptoms at rest, requiring narcotic analgesia. Intravascular ultrasound examination showed evidence of plaque hemorrhage. Examination of the plaque specimen obtained by directional atherectomy confirmed intraplaque hemorrhage, plaque rupture, and intraluminal thrombus. The findings in this patient document that plaque hemorrhage, plaque rupture, and luminal thrombosis may cause a crescendo pattern of lower-extremity claudication.