Optical coherence tomography findings during "evolving" stent thrombosis

Stent thrombosis is a rare but feared complication. While intravascular ultrasound and optical coherence tomography are frequently used to unravel mechanical predisposing factors in patients suffering from this dreadful complication, no information exists on the early pathophysiology of stent thrombosis before coronary flow has been interrupted. We present a case where optical coherence tomography was used to gain novel insights into the earliest stages of stent thrombosis. In our patient with a possible "evolving" stent thrombosis, optical coherence tomography revealed a unique "spider web-like" or "cheese-like" thrombus morphology not previously reported.