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Difficult Wiring of a Recanalized Thrombotic Lesion in the Right Coronary Artery Analyzed with Optical Coherence
Takeshi Niizeki1, Eiichiro Ikeno1, Tadateru Iwayama1
1Department of Cardiology, Okitama Public General Hospital, Yamagata City, Yamagata, Japan.
Insights
Recanalized thrombi, often missed by angiography, present multiple channels. Optical coherence tomography (OCT) helps identify these complex lesions during percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Recanalized thrombi in coronary arteries are often undetected by conventional coronary angiography.
- These lesions can exhibit multiple channels, leading to difficulties during percutaneous coronary intervention (PCI).
Observation:
- A case report details an 87-year-old male experiencing chest pain with significant proximal right coronary artery stenosis.
- Angiography showed irregular filling and haziness, making wire crossing challenging, necessitating a parallel wire technique.
- Optical coherence tomography (OCT) revealed multiple small, honeycomb-like channels, indicative of recanalized thrombi, which were ambiguous on angiography and intravascular ultrasound.
Findings:
- OCT provides detailed visualization of the complex microanatomy of recanalized thrombotic lesions.
- The honeycomb appearance on OCT accurately identifies recanalized thrombi, explaining difficult wiring during PCI.
- Recanalized thrombi can have channels leading to side branches, complicating procedural navigation.
Implications:
- OCT is crucial for accurate assessment of recanalized thrombotic lesions during PCI.
- Awareness of the multi-channel nature of these lesions is essential for successful intervention.
- Careful wire monitoring is recommended during PCI for recanalized thrombotic lesions to ensure optimal outcomes.
Abstract:
BACKGROUND Recanalized thrombi are usually unrecognized in conventional coronary angiography. However, multiple channels have been observed in recanalized thrombotic lesions. Therefore, the wire apparently crosses the lesion in some difficult cases. We analyzed the cause of difficult wiring of a recanalized thrombotic lesion using optical coherence tomography (OCT). CASE REPORT An 87-year-old man with chest pain was admitted to our hospital. Coronary angiography showed significant stenosis of the proximal right coronary artery with irregular linear filling and haziness. Crossing of the wire for the lesion was very difficult but was achieved using a parallel wire technique. OCT clearly demonstrated multiple small channels which had ambiguous findings on angiography and intravascular ultrasound. These structures showed a honeycomb-like appearance suggests the recanalized thrombi. A drug-eluting stent was subsequently deployed to fully cover the entire lesion. CONCLUSIONS OCT is useful to evaluate the accurate tissue characteristics of a recanalized thrombotic lesion. Because recanalized thrombi have multiple small channels and since there are some cases in which a part of the channel only flows into a side branch, it is necessary to carefully monitor wiring at the time of percutaneous coronary intervention.
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