Author + information
- Received October 3, 2013
- Accepted October 9, 2013
- Published online June 1, 2014.
- Sunki Lee, MD∗,†,
- Chang-Soo Kim, BS‡,
- Dong Joo Oh, MD, PhD†,
- Hongki Yoo, PhD‡∗∗ ( and )
- Jin Won Kim, MD, PhD∗,†∗ ()
- ∗Multimodal Imaging and Theranostic Laboratory, Korea University Medical School, Seoul, Republic of Korea
- †Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
- ‡Biomedical Optics and Photomedicine Laboratory, Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
- ↵∗Reprint requests and correspondence:
Dr. Jin Won Kim, Korea University Guro Hospital, 97, Gurodong-gil, Guro-gu, Seoul 152-703, Republic of Korea.
- ↵∗∗Dr. Hongki Yoo, Biomedical Optics and Photomedicine Laboratory, Department of Biomedical Engineering, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul 133-791, Republic of Korea.
A 47-year-old man was emergently referred from another tertiary care center for percutaneous coronary intervention to the left main coronary artery (LM). Diagnostic coronary angiography (CAG) indicated a critical stenosis at the LM ostium (Fig. 1A, arrow) and haziness in the proximal to mid–left anterior descending coronary artery (LAD) (Fig. 1A, dotted line). Intravascular ultrasound showed a heavy plaque burden at the LM ostium (Fig. 1B). Emergent stent implantation was performed with a Resolute Integrity 4.0- × 12-mm stent (Medtronic Vascular, Santa Rosa, California) from the ostium to the mid-body of the LM. Because the chest pain was not relieved after stenting, optical coherence tomography (OCT) (C7-XR system, C7 Dragonfly catheter, LightLab Imaging, St. Jude, Minneapolis, Minnesota) was done to more accurately assess the thrombotic lesion in the proximal to mid-LAD. Longitudinal OCT images clearly showed the intimal-medial dissection in the thrombotic LAD lesion. In cross-sectional OCT images, the true lumen was separated from the false lumen with the “entry” and the “re-entry door” sites, which strongly suggested spontaneous coronary artery dissection (SCAD) in the proximal LAD. The 3-dimensional (3D)-rendered OCT imaging on a stack of the color-coded 2D images using a Digital Imaging and Communications in Medicine (DICOM) viewer and OsiriX software (version 3.9.1; OsiriX Foundation, Geneva, Switzerland) clearly revealed the SCAD morphology (Fig. 2A, 2C), showing a proximal entry tear, dissection flap (Fig. 2B, arrow), and re-entry tear to the true lumen in the distal part (Fig. 2D, arrowhead). Because of the sustained flow limitation in the LAD, a Resolute Integrity 3.0- × 30-mm stent (Medtronic Vascular) was implanted in the LAD SCAD lesion. Final angiogram and post-stenting 3D-rendered OCT image showed optimal results, with Thrombolysis In Myocardial Infarction flow grade III (Figs. 1C and 3). Because the IV-OCT 3D-rendered images can identify coronary structures more accurately (1,2), automatic 3D-OCT rendering technology under development could be helpful to guide an optimal therapeutic strategy for SCAD patients.
The authors thank Byoung Won Cheon and Woong Seo for their excellent technical assistance.
This research was supported in part by a grant through the National Research Foundation of Korea (NRF) funded by the Korea Government (NRF-2012R1A2A2A04046108 to Drs. H. Yoo and J. W. Kim) (NRF-2012R1A1A1041203, to Dr. H. Yoo), and the Korea University Grant (2012K1220481 to Dr. J. W. Kim). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Lee and Mr. C.-S. Kim contributed equally to this work. Drs. H. Yoo and J. W. Kim shared senior authorship.
- Received October 3, 2013.
- Accepted October 9, 2013.
- American College of Cardiology Foundation
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