Optical coherence tomography in primary percutaneous coronary intervention: Helping to clear the angiographic fog

Abstract

The finding of patent arteries on coronary angiography in patients hospitalized for ST-segment elevation myocardial infarction (STEMI) is not a rare phenomenon in daily practice. However, in a subgroup of these cases, namely patients with a history of drug-eluting stent implantation, intracoronary optical coherence tomography (OCT) may reveal angiographically silent stent thrombosis. We describe the case of a 64-year-old man admitted with clinical, electrocardiographic and biological features of STEMI, despite an angiographically patent stent and non-significant lesions in the coronary arteries. We emphasize the role of OCT in diagnosing the culprit artery, the etiopathologic substrate and therapeutic management in such cases.