Patient description: A 46-year-old man presents with dizziness and frequent headaches. He has a family history of CAD, but no other cardiovascular risk factors such as smoking, high blood pressure, and diabetes mellitus and is physically active. The patient's LDL-C and HDL-C levels were 545 and 53 mg/dL, respectively. His fasting glucose and triglyceride levels (85 and 158 mg/dL, resp.) were within normal limits. The patient reported no use of lipid-lowering medications. Neck auscultation revealed a systolic murmur 3+/6+ in the neck, radiating to the skull. Ultrasonography of the carotid arteries, revealed severe stenosis in the left internal carotid artery (LICA), as well as moderate stenosis in the right internal carotid artery (RICA) estimated between 40% and 50%. For the LICA, the peak-systolic (PSV) and end-diastolic velocity (EDV) cutoff values were 208.5 cm/s and 54.5 cm/s, respectively; RICA PSV was 91.72 cm/s and RICA EDV was 37.37 cm/s. Plaque was observed in the anterior and posterior walls of the internal carotid artery and common carotid artery, which were characterized as bulky plates extending to the middle third of the internal coronary arteries (ICAs) and as predominantly echogenic and hyperechoic, with less than 50% of the area being echolucent with uneven surfaces.

Clinical trial eligibility criteria: eligible ages (years): 18.0-79.0,  Coronary Artery Disease Patient Characteristics 1. Males and non-pregnant females > 18 and < 79 years of age 2. Patients referred for diagnostic coronary angiography who are found to have lesions in native coronary arteries which will be treated by percutaneous coronary intervention (PCI) (or patients with known coronary lesions who are referred for planned PCI) 3. Able to give written informed consent Lesion Characteristics 1. Lesion in native coronary artery 2. Angiographic stenosis > 50% 3. Reference vessel diameter 2.5 mm 0 mm by visual estimation 4. Subjects who have successful PCI and OCT General  Subjects who are unable or unwilling to sign the informed consent form 2. Subjects with serious co-morbid conditions that in judgment of the investigator preclude in this study (such as terminal cancer, life expectancy < 6 months, Liver Function Tests (LFTs) > 3 times Upper Limit of Normal (ULN), or post-transplant) 3. Subjects with New York Heart Association (NYHA) class III or IV heart failure or known left ventricular ejection fraction < 30% 4. Subjects who have experienced an ST-elevation myocardial infarction (STEMI) within 72 hours prior to the procedure 5. Subjects with hemodynamic or electrical instability (including shock) 6. Subjects diagnosed with severe, non-catheter-related coronary artery spasm 7. Subjects who are or may be pregnant 8. Subjects with known allergies to contrast media 9. Subjects with renal failure as defined by estimated Glomerular Filtration Rate (eGFR) < 60. 10. History of Transient Ischemic Attack (TIA) or stroke < 6 months Lesion Specific These apply to the target lesion to be imaged by NIRS IVUS. 1. Lesion located in the left main coronary artery 2. Lesions that are heavily calcified 3. Lesions where OCT cannot be performed due to technical difficulties 4. Other lesions that the investigator deems inappropriate for the procedure such as lesions with excessive tortuosity, presence of thrombus, low flow by TIMI grade