Utility of Optical Coherence Tomography to Assess a Hazy Intracoronary Image after Percutaneous Coronary Intervention
A 73-year-old female patient underwent coronary angiography after being admitted with a non-ST elevation myocardial infarction. We determined that the patient had 2 diseased coronary vessels, with the culprit lesion in the right coronary artery (RCA) and a severe lesion in the left anterior descending artery (LAD) (). We treated the RCA lesion with implantation with a bare metal stent (BMS). We deferred treatment of the LAD lesion for 3 weeks. The patient remained asymptomatic until the second procedure.\nTen hours before the second procedure, the patient was given a sub-cutaneous dose of 1 mg/kg enoxaparin. Following the current recommendation guidelines, we gave the patient a 0.3 mg/kg enoxaparine dose by intravenous administration immediately before the angioplasty procedure; we decided against giving the patient unfractionated heparin. We performed a predilatation procedure using a compliant balloon angioplasty in the LAD without angiographic complications, and after that we implanted a BMS of 2.5×23 mm. In the control post-PCI angiography, we found a focal, intra-stent repletion defect (), with distal Thrombolysis in Myocardial Infarction 3 flow. Because of the uncertain interpretation by angiography, we decided to perform OCT in order to ascertain the mechanism of the angiographic hazy image (dissection, thrombus, plaque prolapse). We used a C7-XR, Saint Jude OCT Frequency Domain System with a Dragon Fly Catheter (St. Jude Medical, St. Paul, MN, USA). The OCT study showed an intra-stent protruding signal rich mass with irregular borders and low-backscattering, a finding compatible with a white thrombus.\nThe stent was fully expanded but showed some strut malapposition at the proximal border (). We performed manual thrombus aspiration and obtained white thrombus material. We postdilated the proximal segment of the stent with a non-compliant balloon. The final result was significant reduction of the thrombus and correction of the stent malapposition ().\nThe patient was discharged 3 days after the procedure and did not experience any additional clinical events. At 4 months follow-up, the patient had remained asymptomatic.