Author + information
- Received December 9, 2013
- Accepted December 20, 2013
- Published online August 1, 2014.
- Suneil Kumar Aggarwal, MBBS, BSc∗ (, )
- Alexander Sirker, MB BChir, PhD,
- Howard Swanton, MA, MD and
- Muhiddin Ozkor, MD, BSc
- ↵∗Reprint requests and correspondence:
Dr. Suneil K. Aggarwal, Department of Cardiology, The Heart Hospital, University College London Hospitals, 16-18 Westmoreland Street, London W1G 8PH, United Kingdom.
A 69-year-old woman was referred to our center with a history of lower chest pain and mild exertional breathlessness. Her past medical history included a coronary angiogram 25 years earlier for chest pain. At that time, she had 1 blocked marginal vessel, and medical therapy was advised.
She underwent coronary angiography at our center. This revealed a normal right coronary artery and an occluded first obtuse marginal branch that was filling retrogradely via collaterals. Additionally, a hazy lesion in the mid-left anterior descending coronary artery (LAD) was noted, with preserved Thrombolysis In Myocardial Infarction flow grade 3 beyond it (Figure 1A, Online Video 1). Given this unusual and indeterminate angiographic appearance, optical coherence tomography (OCT) was performed using a C7 Dragonfly OCT catheter (St. Jude Medical, Saint Paul, Minnesota). The OCT images showed multiple channels in the vessel over this segment, which coalesced distally (Figures 1B, 1C, and 1D, Online Video 2). These appearances were consistent with a recanalized occlusion of the LAD and allowed distinction from other causes of hazy angiographic appearances such as thrombus, dissection or complex atheromatous plaque.
A cardiac magnetic resonance scan with stress adenosine perfusion was performed to evaluate the functional significance of this LAD lesion. This revealed no evidence of ischemia or infarction in the LAD territory.
Given these results, it was decided that she should continue to be treated medically. She was well at her most recent follow-up appointment.
This case highlights the utility of OCT in clarifying indeterminate angiographic images and assisting clinical decision making. The case also demonstrated that, even with such multiple septation of the LAD lumen, coronary flow reserve can remain sufficient to prevent ischemia on stress.
For the supplemental videos, please see the online version of this paper.
- Received December 9, 2013.
- Accepted December 20, 2013.
- American College of Cardiology Foundation