2023 Volume 87 Issue 6 Pages 852-
A 76-year-old man with dyslipidemia and a smoking habit suffered from effort-related chest pain for 3 months without any episodes of hemodynamic collapse. Coronary computed tomography revealed a chronic total occlusion in the left anterior descending artery with collateral circulation from a severely stenotic right coronary artery (RCA; Figure A) as the culprit lesion for the unstable angina. Optical coherence tomography (OCT) revealed a honeycomb-like structure (HLS) with multiple, communicating channels of various sizes with a smooth septum (Figure B). Angioscopy visualized the HLS as a white, filamentous structure (Figure C). After implantation of a drug-eluting-stent following excimer laser coronary angioplasty, postprocedural angiography showed optimal results (Figure D).
(A) RCA angiography showing severe stenosis (red arrow) and aneurysm (yellow arrow) (LAO 60 and LAO 30 /cranial 30). (B) OCT revealing the honeycomb-like structure (HLS), Inset: ②–⑤. (C) Angioscopic finding at red arrow in (A). Inset: ①,②. (D) Finnal angiography (LAO 30/CRA 30). LAO, left anterior oblique; OCT, optical coherence tomography; RCA, right coronary artery.
The first report of HLS was in 2002, and it was thought to be derived from recanalization of thrombus.1 However, the mechanism of HLS formation has not been elucidated, and the absence of severe acute coronary events suggest that in this case the HLS was not derived from recanalization of a thrombotic occlusion, but more likely through the plaque healing process. Already found in other diseases such as chronic thrombotic pulmonary hypertension,2 and venous thromboembolism,3 angioscopy might reveal HLS more frequently and lead to addressing the role of plaque healing in clinical events.
T.I. is a member of Circulation Journal’s Editorial Team.
