Repeated plaque rupture in the same bypass graft.

A 51-year-old man experienced a plaque rupture at the site of a shallow plaque in his anterior descending bypass graft and went on to suffer a myocardial infarct. Angiography, five months later, showed excellent recanalization; however, one month after that angiogram, the patient presented with unstable angina and evidence of plaque rupture at the same site. The presence of plaque in a graft indicates risk for future plaque rupture, but there appear to be no definite indicators to identify the specific plaque that is at highest likelihood of rupture.