Author + information
- Received July 3, 2017
- Accepted July 11, 2017
- Published online November 20, 2017.
- Armando Vergara-Martel, MS,
- Gabriel Tensol Rodrigues Pereira, MD,
- Hiram G. Bezerra, MD, PhD,
- Emile Mehanna, MD and
- Guilherme F. Attizzani, MD∗ ()
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Guilherme F. Attizzani, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106.
A 67-year-old man presented with unstable angina of 2 weeks’ duration. Coronary angiography was performed and showed a hazy lesion in the distal left main coronary artery (LMCA) extending into the left anterior descending (LAD) ostium (Figures 1A and 1B). A heart team discussion was initiated to decide on candidacy for coronary artery bypass graft surgery versus high-risk left main percutaneous coronary intervention.
In an attempt to better characterize the angiographically ambiguous lesion, optical coherence tomography (OCT) was subsequently performed on the distal LMCA and LAD ostium, and revealed an intraluminal red thrombus (Figures 1C to 1E). Furthermore, quantitative analysis revealed a minimal lumen area of 6.75 mm2 (Figure 1D). Given the high resolution and 100% sensitivity in detecting intracoronary thrombus (1), the decision was to proceed with intracoronary tissue plasminogen activator injection. Excellent angiographic results were achieved post-lysis (Figure 2), leading to deferral of any further intervention with percutaneous coronary intervention or coronary artery bypass grafting. The patient was asymptomatic at his 6 months’ follow-up.
Our report continues to highlight the inherent limitations of angiography and the importance of OCT in characterizing angiographically ambiguous lesions. OCT-derived plaque characterization and accurate minimal lumen area determination guided the treatment by confirming the presence of thrombus and demonstrating coronary patency, thus allowing optimization of patient care delivery.
Dr. Bezerra is a consultant for St. Jude Medical. Dr. Attizzani is a proctor for Edwards Lifesciences and Medtronic; a consultant for St. Jude Medical; and on the speakers bureau of Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 3, 2017.
- Accepted July 11, 2017.
- 2017 American College of Cardiology Foundation