A honeycomb-like structure in chronic total occlusion demonstrated by frequency-domain optical coherence tomography

Abstract

A 68 year-old male with a history of hypertension and current smoking was admitted due to exertional chest pain. Coronary angiography (CAG) showed a chronic total occlusion (CTO) in the left circumflex artery with collateral supply from the right coronary artery (Fig. 1). PCI was performed in this lesion as patient has normal left ventricular function. After crossing the lesion with a guide wire (Gaia 2nd) and micro catheter, frequency-domain optical coherence tomography (FD-OCT) (ILUMIEN™ OCT Imaging System, St Jude Medical, Inc, St Paul, Minnesota) was performed. FD-OCT showed fibrous/calcified plaque and white thrombus (Fig. 2C–E ). Furthermore FD-OCT showed a honeycomb-like structure (Fig. 2B) at the proximal part of the entry site of the CTO lesion. After balloon angioplasty, this lesion was treated with everolimus-eluting stent (EES 3.0 × 38 mm/2.5 × 18 mm, Xience Xpedition, Abbott Vascular, Santa Clara, California) implantation (Fig. 3). Fig. 2Coronary angiogram and FD-OCT images of LCX CTO lesion after guide wire crossing. Show full caption Coronary angiogram shows the CTO lesion after guide wire crossing. Red dotted line shows the CTO lesion. Yellow dotted lines correspond to the FD-OCT cross sectional images. FD-OCT shows the fibrous and calcified plaque (A) in non-CTO lesion. At the proximal lesion very close to the CTO entry site, FD-OCT shows a honeycomb-like structure (B). Panels C–E show the fibrous and calcified plaque (red arrows) with white thrombus (white arrows) in the CTO lesion. Panel F shows the fibrotic plaque in non-CTO lesion. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) View Large Image Figure Viewer Download Hi-res image Fig. 3Coronary angiogram image of LCX after EES implantation. Show full caption Angiogram shows good stent expansion after EES implantation (3.0 × 38 mm/2.5 × 18 mm). View Large Image Figure Viewer Download Hi-res image Coronary angiogram shows the CTO lesion after guide wire crossing. Red dotted line shows the CTO lesion. Yellow dotted lines correspond to the FD-OCT cross sectional images. FD-OCT shows the fibrous and calcified plaque (A) in non-CTO lesion. At the proximal lesion very close to the CTO entry site, FD-OCT shows a honeycomb-like structure (B). Panels C–E show the fibrous and calcified plaque (red arrows) with white thrombus (white arrows) in the CTO lesion. Panel F shows the fibrotic plaque in non-CTO lesion. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) Angiogram shows good stent expansion after EES implantation (3.0 × 38 mm/2.5 × 18 mm).