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Updated: Jul 6, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Diagnosis and treatment of angiographically unclear coronary lesions
Bojan Maričić1, Zoran Perišić1,2, Tomislav Kostić1,2
1Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia.
Insights
This case study highlights a chronic coronary dissection/recanalized thrombus, emphasizing that treatment decisions for coronary artery disease should prioritize myocardial ischemia. Revascularization is recommended for ischemic lesions, while others may be managed medically.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Selective coronary angiography is standard for diagnosing coronary lesions but lacks pathophysiologic detail.
- Chronic coronary dissection/recanalized thrombus presents diagnostic challenges.
- Pronounced angina necessitates thorough investigation of coronary artery disease.
Purpose of the Study:
- To describe a case of chronic coronary dissection/recanalized thrombus.
- To illustrate the utility of optical coherence tomography (OCT) in characterizing complex coronary lesions.
- To emphasize the role of ischemia in guiding revascularization decisions.
Main Methods:
- Coronary angiography to identify lesion morphology and flow.
- Optical coherence tomography (OCT) for detailed lumen and thrombus characterization.
- Percutaneous coronary intervention (PCI) for a hemodynamically significant lesion.
Main Results:
- Coronary angiography suggested chronic dissection/recanalized thrombus with TIMI grade 2 flow.
- OCT revealed a recanalized thrombus with multiple lumens and thin septa.
- Post-PCI OCT confirmed optimal stent deployment and positive vessel remodeling.
Conclusions:
- Complex coronary lesions like recanalized thrombus require advanced imaging for accurate diagnosis.
- Myocardial ischemia is the critical determinant for revascularization versus medical management in coronary artery disease.
- Percutaneous coronary intervention can be effective for managing ischemic symptoms caused by such lesions.
Abstract:
Although selective coronary angiography is the gold standard diagnostic technique for coronary lesions, this method does not provide all information regarding pathophysiologic mechanisms. We herein describe a patient in their early 60s with a 3-month history of pronounced angina. Coronary angiography revealed a central line of illumination in the proximomedial segment of the right coronary artery, suggesting a chronic coronary dissection/recanalized thrombus, along with positive remodeling and TIMI grade 2 flow. Optical coherence tomography showed a recanalized thrombus and multiple lumens separated by thin septa. Because of the significantly reduced flow and signs of ischemia in the right coronary artery irrigation territory, we decided to perform percutaneous coronary intervention. Post-treatment optical coherence tomography indicated optimal apposition and expansion of the stents with positive remodeling of the blood vessel. We believe that decisions regarding treatment modalities should be guided by the presence or absence of ischemia. Lesions that are causing myocardial ischemia should be revascularized; otherwise, medical treatment can be utilized.
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