PMC524185_01
Composite image showing an angiographic right anterior oblique projection of the left coronary system (Panel B) and two intravascular ultrasound images (Panels A&C) before the intervention. Dotted line shows the approximate location of the IVUS slices. An eccentric plaque is visible in the proximal left anterior descending artery (Panel B), with some haziness at the distal end. IVUS confirms the presence of the plaque (Panel A) and shows a bulky, partially organized, thrombus (Panel C) loosely attached to the distal end of the plaque. No signs of plaque rupture are visible.
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F1
This demonstrated mural thickening of the proximal left anterior descending (LAD) coronary artery with a possible filling defect at the distal end of the lesion but no evidence of coronary atherosclerosis elsewhere (Fig. 1B). Interrogation of the proximal LAD stenosis with IVUS (Galaxy II system; Atlantis 40 MHz Catheter, Boston Scientific/Scimed, Inc., Maple Grove, Minnesota) showed a large intracoronary thrombus (Fig. 1C) adherent to a mural atheromatous plaque starting at the ostium of LAD (Fig. 1A).
Composite image showing an angiographic right anterior oblique projection of the left coronary system (Panel B) and two intravascular ultrasound images (Panels A&C) after the intervention. Dotted line shows the approximate location of the IVUS slices. An excellent angiographic result is visible on the left anterior descending (Panel A). IVUS confirms good apposition of the stent (Panel A&B), with no residual or prolapsed thrombus.
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F2
Abciximab was administered. A 4.0 x 15 mm stent was placed directly with good final angiographic result (Fig. 2B) and no evidence of macroscopic distal embolisation. Repeat IVUS confirmed good apposition of the stent and the absence of residual thrombus (Fig. 2A&2C).