PMC5498198_01
Baseline coronary angiography. Right coronary artery (A: LAO view). No atheroscrelotic lesions are observed. Left coronary artery (B: RAO caudal view, C: LAO cranial view, D: LAO caudal view). Tubular stenosis can be seen in the proximal LAD.This lesion has two linear contrast defects, which divide the lumen into a central lumen and lateral multiple small channels. There are no other atherosclerotic lesions in the distal LAD, LCx, and the RCA. Magnified pictures in the lower panels of B, C, and D reveal similar finding for this lesion. LAO: left anterior oblique, RAO: right anterior oblique, LAD: left anterior descending artery, LCx: left circumflex artery
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She was diagnosed to have acute coronary syndrome and therefore underwent emergent coronary angiography (Fig. 1), which revealed severe stenosis with lateral small channels in the proximal left anterior descending artery (LAD). Before PCI she underwent OCT (Fig. 2) and IVUS (Fig. 3) because of unusual angiographic findings (Fig. 1).
Optical coherence tomography before PCI. In the stenosis, a central lumen and circumferential small channels separated by thick high intensity septum are detected (A). Floating white thrombus can be detected just distal to the stenosis (B). The whole structure of this lesion can be detected by longitudinal section of optical coherence tomography (C). A white arrow indicates the central lumen. The red arrows indicate the multiple small channels surrounding the central lumen. Two white arrow heads show white thrombi.
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Before PCI she underwent OCT (Fig. 2) and IVUS (Fig. 3) because of unusual angiographic findings (Fig. 1). Although this lesion showed a so called honeycomb- or lotus root-like appearance, the inter luminal septum was circular and thick in our case (Fig. 2A and B). White thrombi were floating distal to the stenosis (Fig. 2B). A longitudinal section revealed the whole structure of the stenotic lesion and white thrombus (Fig. 2C).
Intravascular ultrasound tomography. The proximal reference vessel has little intimal hyperplasia (A). The stenotic lesion (B) shows the presence of a donut-shaped material with heterogeneous echogeneity. A circular narrow low echoic space is detected outside of this material.
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IVUS showed a donut-shaped material with broad band and heterogeneous echogeneity in the lesion (Fig. 3).
Final coronary angiography after PCI. Excellent results were obtained. Neither any residual stenosis nor thrombus was found in the RAO caudal (A) and the LAO cranial (B) views. PCI: percutaneous coronary intervention, RAO: right anterior oblique, LAO: left anterior oblique
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Thrombolysis in the myocardial infarction (TIMI) 3 coronary flow could be achieved after Filtrap retrieval (Fig. 4).
Optical coherence tomography at the six-month follow-up. Although restenosis was not detected by angiography, significant amount of intimal hyperplasia could be detected.
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Follow-up coronary angiography at six months showed no restenosis and OCT revealed diffuse in-stent intimal hyperplasia (Fig. 5).