Honeycomb or Lotus Root-Like Intracoronary Pattern: Insights From Optical Coherence Tomography of a Recanalized...

Spontaneous recanalized coronary thrombus (SRCT) has been identified in autopsy studies as multiple interconnected channels separated by thin septa. Despite its potential clinical significance, SRCT remains underdiagnosed. Recent advances in intracoronary imaging, including optical coherence tomography (OCT), have elucidated its pathophysiology, angiographic patterns, and therapeutic strategies. This review summarizes the epidemiological data, angiographic and OCT features, histopathological correlations, physiopathology, and interventional strategies for SRCT. A comprehensive literature review was performed, including data from dedicated registries and studies employing advanced intracoronary imaging modalities. Patients with SRCT are predominantly men in their fifth decade of life with cardiovascular risk factors and a history of acute or chronic coronary syndromes. Angiographic findings frequently include a braid-like or hazy appearance with TIMI 3 distal flow. OCT imaging reveals honeycomb-like patterns of multiple microchannels divided by fibrous septa. Histopathology corroborates these findings, highlighting organized thrombus with endothelialized septa and atherosclerotic features. Functional assessments indicate that most lesions are hemodynamically significant (FFR < 0.8). Treatment strategies include drug-eluting stents (DES) and drug-coated balloons, with post-procedural OCT confirming lesion resolution. Challenges include side branch occlusion during an intervention, necessitating specific technical considerations to mitigate risks. SRCT is a distinct pathological and imaging entity characterized by multiple communicating channels. Advanced imaging and physiological assessment are pivotal for accurate diagnosis and management. DES remains the cornerstone of treatment, but procedural planning must address the risk of side branch occlusion. Further studies are warranted to explore long-term outcomes and optimize therapeutic approaches.