Healed Erosion: The Role of Pre-interventional Optical Coherence Tomography in a Patient Clinically Suspected of Having Unstable Angina with Coronary Spasm

A 46-year-old man complained of chest pain at rest for the past three months. His symptoms gradually exacerbated and were suspected of being due to unstable angina. A coronary angiogram revealed focal tight stenosis at the proximal left anterior descending coronary artery with gross spastic coronary...

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Bibliographic Details
Published in:Internal Medicine 2021/07/15, Vol.60(14), pp.2241-2244
Main Authors: Okabe, Hiroki, Sonoda, Shinjo, Naka, Yutaro, Setoyama, Koshi, Inoue, Konosuke, Miura, Toshiya, Anai, Reo, Tsuda, Yuki, Araki, Masaru, Otsuji, Yutaka
Format: Article
Language:English
Subjects:
Angina
Angina pectoris
Case Report
Coronary artery
coronary spasm
Drug delivery
drug-coated balloon
healed plaque
Implants
Internal medicine
Macrophages
optical coherence tomography
Restenosis
Stents
Thrombosis
Tomography
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Summary:A 46-year-old man complained of chest pain at rest for the past three months. His symptoms gradually exacerbated and were suspected of being due to unstable angina. A coronary angiogram revealed focal tight stenosis at the proximal left anterior descending coronary artery with gross spastic coronary findings. Optical coherence tomography (OCT) revealed layered low-intensity structures with microvessels and the accumulation of macrophages, which indicated progressive stenosis with multiple-layered organized thrombus caused by coronary erosion. We treated the stenosis using a drug-coated balloon instead of drug-eluting stents. There was no restenosis, and OCT revealed good plaque healing at follow-up. This case suggests that the pre-interventional OCT plaque morphology can have a positive impact on the revascularization strategy.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.6119-20