Author + information
- Received July 25, 2016
- Accepted July 28, 2016
- Published online October 24, 2016.
- Sei Komatsu, MDa,∗ (, )
- Tomoki Ohara, MDa,
- Satoru Takahashi, MDa,
- Mitsuhiko Takewa, MDa,
- Chikao Yutani, MDb and
- Kazuhisa Kodama, MDa
- aCardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
- bDepartment of Pathology, Osaka Gyoumeikan Hospital, Osaka, Japan
- ↵∗Reprint requests and correspondence:
Dr. Sei Komatsu, Nishi-kujo 5-4-8, Konohana-ku, Osaka, Japan 554-0012.
A 76-year-old man underwent coronary angiography to treat unstable angina with a rest angina for a week. It revealed severe stenosis in the middle of left circumflex artery (Figure 1A, arrow). Percutaneous coronary intervention was performed using a 3.0 × 15-mm Xience V stent (Abbott Vascular, Santa Clara, California), with subsequent pre-dilation using a 3.0 × 15-mm TREK balloon (Abbott Vascular) (Figure 1B). Coronary angiography did not show aneurysmal formation or dissection proximal to the stented site (Figure 1B, arrow). Nonobstructive angioscopy revealed yellow intima at the proximal edge of the stent (Figure 1C). The yellow surface then suddenly changed to wide subintimal bloody staining with some branches like flames (Figures 1C and 1D, Online Video 1) and pulsated flows (Figures 1E and 1F, arrows). They did not communicate with the coronary blood flow. The irregular subintimal arterial bleeding might be related to injury of plaque smaller than the detection limit of intravascular ultrasound images, because they did not reveal a slit or dissection (Figures 1G and 1H).
For a supplemental video and legend, please see the online version of this article.
Dr. Kodama is the president of Inter-tec Medicals, Co., Ltd., and originally developed nonobstructive angioscopy. Dr. Komatsu is a technical consultant for Nemoto Kyorin-do Co., Ltd.
- Received July 25, 2016.
- Accepted July 28, 2016.
- 2016 American College of Cardiology Foundation