Coronary artery thrombus recanalisation: documentation by optical coherence tomography caused by angiographic haziness

CARDIOVASCULAR INTERVENTION IMAGE

Coronary artery thrombus recanalisation: documentation by optical coherence tomography caused by angiographic haziness

Daniel Chamié^I; Alexandre Abizaid^II

^IInterventional cardiologist in the Department of Invasive Cardiology of the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil

^IILecturer. Director of Invasive Cardiology Service of the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil

^{Correspondence}

57-year-old male patient with a history of myocardial infarction two months before was treated conservatively. Coronary angiography evidenced a single lesion in the middle segment of the right coronary artery, with intraluminal haziness and preserved distal flow (Thrombolyis in Myocardial Infarction [TIMI] 3) (Figure 1).

An evaluation with optical coherence tomography was performed in order to assess the morphology and composition of stenosis, in addition to guiding the intervention procedure.

Figures 1 and 2 show a complex structure, with the vascular lumen divided into multiple cavities separated by high-intensity tissue and low attenuation of the optical signal, suggesting the presence of an organized, white, recanalized thrombus, which was crossed using a 0.014-inch hydrophilic guide with mouldable tip.

Recanalisation or neovascularisation has been described by pathological studies in approximately one-third of old thrombotic coronary occlusions. Its size can vary, and it is characterized by multiple vascular channels created within the thrombus, with its surface covered by endothelium and separated by thin strands of connective tissue. This phenomenon is often underdiagnosed in angiographic studies. Although frequently found at the angiography, intraluminal filling defects are nonspecific findings, and may correspond to several other pathological conditions, such as dissections, plaque rupture, calcification, aneurysms, and fresh thrombi. In this case, the use of optical coherence tomography allowed for the diagnosis and detailed morphological evaluation of the lesion with intraluminal haziness at the angiography.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

Received: 04/16/2013

Accepted on: 05/30/2013

Publication Dates

• Publication in this collection
  01 July 2013
• Date of issue
  June 2013