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Optical coherence tomography-guided approach in diagnosing and managing spontaneously recanalized coronary thrombus
Mohamed El Minaoui1, Wafa Id El Mouden1
1Cardiology Department, University Hospital Agadir, Medical School of Medicine & Pharmacy Ibn Zohr University, Agadir, Morocco.
Insights
Recanalized coronary thrombus, a rare condition, is increasingly diagnosed with intracoronary imaging. Optical coherence tomography aids in identifying this chronic occlusion for successful intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Recanalized coronary thrombus is a rare finding in chronic coronary occlusions.
- Its incidence is rising due to advancements in endo-coronary imaging.
- Pathological studies describe it as multiple endothelium-covered channels within a chronic occlusion.
Observation:
- Angiography often misidentifies recanalized thrombus as fresh thrombus, dissection, or calcification.
- Intracoronary imaging, especially optical coherence tomography (OCT), is crucial for accurate diagnosis.
- This case highlights the diagnostic utility of OCT in a patient with suspected coronary occlusion.
Findings:
- Optical coherence tomography (OCT) conclusively diagnosed recanalized coronary thrombus.
- The imaging findings guided the therapeutic strategy for percutaneous coronary intervention.
- Successful percutaneous coronary intervention was achieved following accurate diagnosis.
Implications:
- Accurate diagnosis of recanalized thrombus using OCT improves treatment strategies.
- Understanding recanalized thrombus mechanisms enhances interventional cardiology practice.
- This case underscores the importance of advanced imaging for complex coronary lesions.
Abstract:
Recanalized coronary thrombus is a rare and under-recognized condition in interventional practice, however its incidence is steadily increasing with the use of endo-coronary imaging. It has been initially described by pathological studies in approximately one-third of chronic coronary occlusions. It is described as a chronic occlusion that constitutes several endothelium-covered channels separated by septa that converge into a single lumen. In angiographic studies, it is often misidentified as fresh thrombus, spontaneous coronary artery dissection or severe calcification. Hence the interest of intracoronary imaging, particularly optical coherence tomography, to conclusively establish its diagnosis and identify the related mechanism in order to guide the optimal therapeutic strategy. In this report, we describe our experience with a case of recanalized thrombus diagnosed using intracoronary optical coherence tomography imaging with successful percutaneous coronary intervention.
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