Difficult Wiring of a Recanalized Thrombotic Lesion in the Right Coronary Artery Analyzed with Optical Coherence Tomography

Abstract

Patient: Male, 87Final Diagnosis: Recanalized thrombotic lesionSymptoms: Chest painMedication: —Clinical Procedure: GoodSpecialty: CardiologyObjective:Rare diseaseBackground:Recanalized thrombi are usually unrecognized in conventional coronary angiography. However, multiple channels have been observed in recanalized thrombotic lesions. Therefore, the wire apparently crosses the lesion in some difficult cases. We analyzed the cause of difficult wiring of a recanalized thrombotic lesion using optical coherence tomography (OCT).Case Report:An 87-year-old man with chest pain was admitted to our hospital. Coronary angiography showed significant stenosis of the proximal right coronary artery with irregular linear filling and haziness. Crossing of the wire for the lesion was very difficult but was achieved using a parallel wire technique. OCT clearly demonstrated multiple small channels which had ambiguous findings on angiography and intravascular ultrasound. These structures showed a honeycomb-like appearance suggests the recanalized thrombi. A drug-eluting stent was subsequently deployed to fully cover the entire lesion.Conclusions:OCT is useful to evaluate the accurate tissue characteristics of a recanalized thrombotic lesion. Because recanalized thrombi have multiple small channels and since there are some cases in which a part of the channel only flows into a side branch, it is necessary to carefully monitor wiring at the time of percutaneous coronary intervention.

Optical Coherence Tomography for In Vivo Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus

“…SRCT were identified, in our study, as culprit or non-culprit lesions for ACS patients. Data from the literature show that the 62 SRCT lesions may be asymptomatic -20 cases (10-12, 20, 22, 26, 28) or symptomatic, associated with stable CAD -23 cases (2,10,13,17,20,21,24,25,(29)(30)(31)(32), UA -5 cases (2,18,27) or acute STEMI -12 cases (2,10,14-16). Other two cases had an undeclared clinical condition (3,23).…”

“…OCT was the only SRCT imaging method for our study, as it was for 56 of the 62 cases reported in the literature (2, 10-12, 14-23, [26][27][28][29]31). IVUS was used in 3 cases (3,24,25), while both OCT and IVUS were used in other 3 cases (13,30,31).…”

A case of right coronary artery chronic total occlusion with difficulty in retrograde system establishment

“…Therefore, we need to improve primary prevention strategies and treatment of cardiovascular disease to reduce worldwide mortality from this disease [5]. The development of devices (guidewires and MCs) and the advance of techniques such as retrograde approach contributed to the improvement in success rates and long-term outcomes for CTO patients [1][2][3]. Even if a guidewire passes retrogradely like in this case, the establishment of the retrograde system may be difficult in some cases since the MC cannot pass retrogradely.…”

“…Guidewires and microcatheters (MCs) have developed remarkably over recent years. Furthermore, the advance of techniques such as retrograde approach has contributed to the improvement of success rates for the interventional treatment of chronic total occlusion (CTO) [1][2][3]. In cases of a long CTO with severe tortuosity or second attempt, there is a high possibility that the retrograde approach will be required.…”

Rotational Atherectomy for Ablation of Multiple Channel Structure Observed by Optical Frequency Domain Imaging

“…However, there have been several advances in treatment modalities. In instances where lesions prevent wires from passing through, double-lumen catheter and parallel wire techniques have been useful for entering adjacent cavities [9]. In addition, scoring and cutting balloons might be effective for penetrating partition walls.…”