JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 7, NO. 8, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2013.12.213
IMAGES IN INTERVENTION
Seeing Through the Haze Optical Coherence Tomography Demonstrates the Unanticipated Cause of a Left Anterior Descending Coronary Artery Lesion Suneil Kumar Aggarwal, MBBS, BSC, Alexander Sirker, MB BCHIR, PHD, Howard Swanton, MA, MD, Muhiddin Ozkor, MD, BSC
A
69-year-old woman was referred to our center
history included a coronary angiogram 25 years
with a history of lower chest pain and mild
earlier for chest pain. At that time, she had 1 blocked
exertional breathlessness. Her past medical
marginal vessel, and medical therapy was advised.
FIGURE 1
Angiographic
Image of a Hazy Lesion in the LAD, With Corresponding OCT Images
(A) This image shows an angiogram of the left anterior descending coronary artery (LAD) with a hazy section noted in the mid-portion the artery (Online Video 1). The arrows indicate the level of optical coherence tomography still images. The OCT images correspond to the center of the lesion where multiple channels are noted (B), towards the distal end of the lesion, where some channels have coalesced (C), and distal to the lesion where there is once again a single channel (D) (Online Video 2).
From the Heart Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom. Manuscript received December 9, 2013; accepted December 20, 2013.
e98
Aggarwal et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 8, 2014 AUGUST 2014:e97–8
OCT Appearances of Hazy LAD Lesion
She underwent coronary angiography at our center.
Given these results, it was decided that she should
This revealed a normal right coronary artery and an
continue to be treated medically. She was well at her
occluded first obtuse marginal branch that was filling
most recent follow-up appointment.
retrogradely via collaterals. Additionally, a hazy lesion
This case highlights the utility of OCT in clarifying
in the mid-left anterior descending coronary artery
indeterminate angiographic images and assisting
(LAD) was noted, with preserved Thrombolysis In
clinical decision making. The case also demonstrated
Myocardial Infarction flow grade 3 beyond it (Figure 1A,
that, even with such multiple septation of the LAD
Online Video 1). Given this unusual and indeterminate
lumen, coronary flow reserve can remain sufficient to
angiographic appearance, optical coherence tomogra-
prevent ischemia on stress.
phy (OCT) was performed using a C7 Dragonfly OCT catheter (St. Jude Medical, Saint Paul, Minnesota).
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
The OCT images showed multiple channels in the
Suneil K. Aggarwal, Department of Cardiology, The
vessel over this segment, which coalesced distally
Heart Hospital, University College London Hospitals,
(Figures 1B, 1C, and 1D, Online Video 2). These appear-
16-18
ances were consistent with a recanalized occlusion of
United Kingdom. E-mail: suneilaggarwal@doctors.
the LAD and allowed distinction from other causes of
net.uk.
Westmoreland
Street,
London
W1G
8PH,
hazy angiographic appearances such as thrombus, dissection or complex atheromatous plaque. A cardiac magnetic resonance scan with stress
KEY WORDS coronary disease, left anterior descending artery, optical coherence tomography
adenosine perfusion was performed to evaluate the functional significance of this LAD lesion. This revealed no evidence of ischemia or infarction in the LAD territory.
A PPE NDI X For the supplemental videos, please see the online version of this paper.
VOL. 7, NO. 8, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2013.12.213
IMAGES IN INTERVENTION
Seeing Through the Haze Optical Coherence Tomography Demonstrates the Unanticipated Cause of a Left Anterior Descending Coronary Artery Lesion Suneil Kumar Aggarwal, MBBS, BSC, Alexander Sirker, MB BCHIR, PHD, Howard Swanton, MA, MD, Muhiddin Ozkor, MD, BSC
A
69-year-old woman was referred to our center
history included a coronary angiogram 25 years
with a history of lower chest pain and mild
earlier for chest pain. At that time, she had 1 blocked
exertional breathlessness. Her past medical
marginal vessel, and medical therapy was advised.
FIGURE 1
Angiographic
Image of a Hazy Lesion in the LAD, With Corresponding OCT Images
(A) This image shows an angiogram of the left anterior descending coronary artery (LAD) with a hazy section noted in the mid-portion the artery (Online Video 1). The arrows indicate the level of optical coherence tomography still images. The OCT images correspond to the center of the lesion where multiple channels are noted (B), towards the distal end of the lesion, where some channels have coalesced (C), and distal to the lesion where there is once again a single channel (D) (Online Video 2).
From the Heart Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom. Manuscript received December 9, 2013; accepted December 20, 2013.
e98
Aggarwal et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 8, 2014 AUGUST 2014:e97–8
OCT Appearances of Hazy LAD Lesion
She underwent coronary angiography at our center.
Given these results, it was decided that she should
This revealed a normal right coronary artery and an
continue to be treated medically. She was well at her
occluded first obtuse marginal branch that was filling
most recent follow-up appointment.
retrogradely via collaterals. Additionally, a hazy lesion
This case highlights the utility of OCT in clarifying
in the mid-left anterior descending coronary artery
indeterminate angiographic images and assisting
(LAD) was noted, with preserved Thrombolysis In
clinical decision making. The case also demonstrated
Myocardial Infarction flow grade 3 beyond it (Figure 1A,
that, even with such multiple septation of the LAD
Online Video 1). Given this unusual and indeterminate
lumen, coronary flow reserve can remain sufficient to
angiographic appearance, optical coherence tomogra-
prevent ischemia on stress.
phy (OCT) was performed using a C7 Dragonfly OCT catheter (St. Jude Medical, Saint Paul, Minnesota).
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
The OCT images showed multiple channels in the
Suneil K. Aggarwal, Department of Cardiology, The
vessel over this segment, which coalesced distally
Heart Hospital, University College London Hospitals,
(Figures 1B, 1C, and 1D, Online Video 2). These appear-
16-18
ances were consistent with a recanalized occlusion of
United Kingdom. E-mail: suneilaggarwal@doctors.
the LAD and allowed distinction from other causes of
net.uk.
Westmoreland
Street,
London
W1G
8PH,
hazy angiographic appearances such as thrombus, dissection or complex atheromatous plaque. A cardiac magnetic resonance scan with stress
KEY WORDS coronary disease, left anterior descending artery, optical coherence tomography
adenosine perfusion was performed to evaluate the functional significance of this LAD lesion. This revealed no evidence of ischemia or infarction in the LAD territory.
A PPE NDI X For the supplemental videos, please see the online version of this paper.
