ABSTRACT
Background: Inflammation is widely recognized as the main driver of atherosclerosis and is directly associated with an increased risk of acute coronary syndromes (ACS). Current non-invasive imaging tools for atherosclerosis focus on the identification and characterization of coronary plaques. In recent years, CT-based assessment of perivascular adipose tissue (PVAT) inflammation has emerged as a useful method for evaluating coronary inflammation, based on calculation of the fat attenuation index (FAI). Case presentation: We report the case of a young patient with a significant family history of cardiovascular disease, admitted several times for recurrent ACS, in whom serial FAI assessment revealed a direct association between the progression of perivascular inflammation and plaque vulnerability. Conclusion: CT-based determination of perivascular inflammation may aid in identifying high-risk plaques and represents a useful tool for monitoring their evolution over time.