A lotus root-like appearance in both the left anterior descending and right coronary arteries

Abstract

A 60-year-old man was referred to our hospital because of dyspnea on exertion. He was diagnosed with heart failure due to an old myocardial infarction. Myocardial stress perfusion scintigraphy revealed inducible myocardial ischemia. Coronary angiography revealed hazy slit lesions in both the left anterior descending (LAD) and right coronary arteries (RCA). We first performed percutaneous coronary intervention (PCI) on the LAD lesion. Subsequently, we performed PCI for the RCA lesion using multiple imaging modalities. We observed a lotus root-like appearance in both the LAD and RCA, and PCI was successful for both vessels. We describe this rare case in detail.

Diagnosis and Management of Spontaneously Recanalized Coronary Thrombus Guided by Optical Coherence Tomography ― Lessons From the French “Lotus Root” Registry ―

“…14 In the present series, there were 7 cases of history of coronary occlusion on previous angiography; in the same vessel, OCT indicated SRCT, confirming the chronic progression of certain occluding thrombi toward SRCT. 5 The present data support the contention that OCTguided management of SRCT is associated with good prognosis. Treatment was mainly by stenting, precluding comparison with other therapies.…”

Instructive percutaneous coronary intervention to avoid the risk of side branch occlusion at a lesion with a lotus root appearance: a case report

“…However, not so many cases have received PCI for this kind of lesion. Several cases verified the validity of performing PCI for these lesions based on a significant decrease of the fractional flow reserve value [ 6 , 7 ]. Functionally significant ischemic findings are often demonstrated at a lesion with a lotus root appearance, whereas the stenosis rate at that lesion angiographically shows a moderate degree.…”

Honeycomb-like structure in the right coronary artery treated with a drug-eluting stent: a case report and literature review

“…In total, 20 studies were evaluated. 1 – 20 The diagnosis of HLS was based on coronary intravascular imaging modalities such as intravascular ultrasound and OCT. OCT is the preferred tool with which to demonstrate detailed structures because of its high spatial resolution (10–15 µm). HLS could be found in all three epicardiac arteries without significant territory dominance.…”

“…In very rare cases, several HLSs could be detected simultaneously in multiple coronary arteries. 5 , 12 , 16 The etiology of HLS is not completely understood. Recanalization of an in situ thrombus has been considered by many researchers to be the pathogenesis of HLS.…”