Longitudinal necrotic shafts near TCFAs-A potential novel mechanism for plaque rupture to trigger ACS?

It has been questioned for over 15 years why only less than 20% of TCFAs trigger ACS.  We illustrate TCFA rupture into adjacent longitudinal necrotic shafts of massive amounts of  thrombogenic material into the blood, leading to catastrophic clot formation.  This is the potential mechanism for TCFAs triggering ACS.  One case presented also illustrates the dangers of stent edges rupturing TCFAs.