Optical coherence tomography evidence of endothelial erosion as a cause of ST-segment elevation myocardial infarction

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Pathophysiology

Background:

• Acute coronary syndromes (ACS) are often linked to plaque rupture, but endothelial erosion is an alternative pathway.
• Understanding the in-vivo mechanisms of ACS is crucial for improving patient outcomes.
• High-resolution intracoronary imaging modalities are essential for detailed pathophysiological assessment.

Observation:

• A case report of a 51-year-old woman with ST-segment elevation ACS.
• Frequency domain optical coherence tomography (FD-OCT) was utilized for intracoronary imaging.
• FD-OCT revealed findings suggestive of endothelial erosion without significant luminal thrombus in the infarct-related artery.

Findings:

• The observed endothelial erosion in the proximal artery segment likely led to distal embolization and thrombotic occlusion.
• This case provides a rare in-vivo visualization of endothelial erosion as a cause of ACS.
• FD-OCT demonstrated its utility in identifying subtle pathological mechanisms in ACS.

Implications:

• Endothelial erosion should be considered as a significant contributor to ACS pathophysiology.
• FD-OCT imaging can provide critical in-vivo insights into ACS mechanisms.
• Further research into endothelial erosion may lead to novel therapeutic strategies for ACS.