Spontaneous Recanalization of a Coronary Artery Following Thrombotic Occlusion. In Vivo Demonstration With Optical Coherence Tomography

- Operator :

Spontaneous Recanalization of a Coronary Artery Following Thrombotic Occlusion. In Vivo Demonstration With Optical Coherence Tomography
- Operator: Jin man Cho, MD
Clinical Information
- Relevant clinical history and physical exam:
A 50 year old man who suffered a left middle cerebral artery embolic stroke 1 month previously, was referred by a neurologist for an abnormal ECG (Figure 1). He denied any history of chest pain.

- Relevant test results prior to catheterization:
Echocardiography showed akinesis of the anteroapical left ventricular wall without obvious mural thrombus and an ejection fraction of 45%. There was no evidence of an intracardiac shunt.

- Relevant catheterization findings:
Coronary angiography was performed, which revealed irregularly shaped linear filling defects in the mid left anterior descending artery (LAD) with TIMI flow grade 3 (Figure 2).

Interventional Management

- Procedural step:
Optical coherence tomography (OCT)1 performed within this region showed multiple channels surrounding a larger central lmen (Figure 3A, arrowheads). The channels were seen to communicate both with each other and the larger central lumen (Figure 4, A-D). Proximally and distally they converged into a single lumen (Figure 3B). Some residual thrombus was still visualized within the smaller channels (Figure 3A, arrow)

Comments

  • Vijay Shah 2009-02-13 Obviously,this seems to be a case of Spontanous Dissection leading to thrombosis,which resulted in an infarct.The dissected artery after the thrombosis got partially recanalized leaving behind multiple channels with hazy filling defects due to residual thrombus.The linear filling defect is due to the intraluminal dissected flaps.....DR V T SHAH...MUMBAI(BOMBAY) ...INDIA.
  • Jin-Man Cho 2009-02-27 Thank you for your comment! OCT provide still more presice local anatomical information than any other modality. But, there are some limitations in OCT. For example shallow penetration depth and tissue characterization. I think the OCT is "way to go"...Seoul, Korea

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