Author + information
- Received July 12, 2010
- Revision received August 10, 2010
- Accepted August 20, 2010
- Published online February 1, 2011.
- Koen Teeuwen, MD⁎,†,
- Bastiaan Zwart, MSc⁎,†,
- Jochem W. van Werkum, MD⁎,†,
- Michael Joner, MD, PhD‡ and
- Jurriën M. ten Berg, MD, PhD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jurriën M. ten Berg, Department of Cardiology, St. Antonius Hospital, P.O. Box 2500, 3435 CM, Nieuwegein, the Netherlands
A 45-year-old man presented to our catheterization laboratory with an acute anterior ST-segment elevation myocardial infarction caused by a proximal occlusion of the left descending artery. Two bare-metal stents were implanted with good angiographic results. Besides aspirin and clopidogrel, the patient was treated with abciximab intravenously because of the large thrombus load.
Eight days later, the patient re-experienced severe chest pain, and emergent coronary angiography showed an acute thrombotic occlusion of the recently implanted bare-metal stents. Optical coherence tomography (OCT) was performed after coronary flow was re-established by thrombosuction. The OCT pullback revealed the underlying pathophysiological mechanism that may have caused the subacute stent thrombosis: severe undersizing of the implanted bare-metal stents with a large residual thrombus on the naked incomplete apposed stent struts (Fig. 1). After OCT pullback, repeated high-pressure balloon inflations were performed resulting in Thrombolysis In Myocardial Infarction flow grade 3.
Three-dimensional (3D) OCT is a novel technique enabling 3D imaging of the intracoronary lumen. In the present case, the 3D image shows a central cavity, which correlates to thrombus on the incomplete apposed stent struts visualized on 2-dimensional OCT. In the near future, 3D OCT may be a useful tool to guide complex coronary interventions. Further research is imperative to assess the clinical relevance of 3D OCT.
Dr. van Werkum has received Speakers' Bureau fees from Accumetrics and Siemens and has provided consultancy services for the Medicines Company. Dr. ten Berg has received Speakers' Bureau fees from Sanofi-Aventis, Lilly and Co., Bristol-Myers Squibb, and Merck and Co., Inc., and has provided consultancy services for Sanofi-Aventis, Eli Lilly, Schering-Plough, and GlaxoSmithKline. All other authors have reported that they have no relationships to disclose.
- Received July 12, 2010.
- Revision received August 10, 2010.
- Accepted August 20, 2010.
- American College of Cardiology Foundation