2019 Volume 83 Issue 3 Pages 688-
A 65-year-old man presented with worsening exertional angina. Coronary angiography (CAG) showed severe stenosis with haziness in the distal left circumflex artery (LCx; Figure A, white circle). Optical coherence tomography (OCT) of the LCx lesion (Movie S1) demonstrated diffuse plaque burden with dissection flap (Figure D,F, arrowheads), also confirmed on 3-dimensional OCT (Figure B, arrowheads), and intimal disruption (Figure D, white arrow), suggestive of plaque rupture. The OCT assessment led to implantation of a 2.75×18-mm Xience Alpine stent (Abbot Vascular, Santa Clara, CA, USA). Repeated OCT demonstrated good strut apposition with intraluminal tissue prolapse (Figure C,E, arrowheads).
Regarding the left anterior descending artery (LAD) lesion, CAG showed multiple linear filling defects with haziness in the mid-LAD (Figure L, dotted line). Cross-sectional (Figure G–K) and longitudinal (Figure M) OCT showed a honeycomb-like structure with multiple channels of various sizes, separated by highly backscattering septa, communicating with each other (Figure G,H,K, white arrow; Movie S2). On OCT of the LAD, we concluded that this characteristic represented recanalized thrombus. The LAD lesion was treated with a 3.0×38-mm Xience Alpine stent and follow-up OCT showed good strut apposition without edge dissection.
The superior resolution of OCT is able to distinguish the etiology of intraluminal events, as highlighted in this case of simultaneously recanalized thrombus and plaque rupture in multivessel lesions, visualized on OCT.
The authors declare no conflicts of interest.
Supplementary File 1
Movie S1. OCT demonstrating plaque rupture in the distal-LCx.
Supplementary File 2
Movie S2. OCT demonstrating a honeycomb-like structure in the mid-LAD.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-18-0526
