Coronary Angioscopy and Optical Coherence Tomography Assessment of the Pathophysiology of Intraplaque Hemorrhage

Histologically, intraplaque hemorrhage (IPH) is a recognized cause of acute coronary syndrome. However, the in vivo lesion characteristics of IPH and mechanisms leading to acute coronary syndrome remain unclear.

A 77-year-old woman presented with chest pain at rest or on light exertion and new electrocardiographic changes. Cardiac computed tomography angiography demonstrated significant stenosis with the napkin-ring sign in the left anterior descending artery. Preintervention optical coherence tomography (OCT) revealed heterogeneous signal-poor regions with delineated borders and a white thrombus. Coronary angioscopy showed reddish plaque with an exposed red thrombus and adjacent white thrombus. OCT after excimer laser coronary angioplasty demonstrated localized ablation of the low-intensity area, suggesting solidified hemorrhagic material.

Combined use of coronary angioscopy and OCT enables comprehensive macroscopic diagnosis and pathophysiological assessment of IPH lesions.

Multiple imaging with coronary angioscopy and OCT provides valuable insights into the mechanism of progression of IPH lesions.