Optical coherence tomography and coronary artery ectasia: the critical role of intracoronary imaging for optimal results of percutaneous coronary intervention

Abstract

Percutaneous coronary intervention (PCI) in coronary artery ectasia is technically challenging, particularly regarding appropriate stent sizing, and it is associated with a higher incidence of adverse events. In this case report, a 63-year-old male patient, heart transplant recipient, underwent elective follow-up coronary angiography in the absence of clinical symptoms. Five years previously the patient was treated with coronary angioplasty and drug-eluting stent implantation for critical lesions of the left anterior descending coronary artery. Angiographic images showed a focal in-stent haziness at the level of an ectatic segment. To elucidate this finding, optical coherence tomography (OCT) was performed. Intracoronary imaging showed severe malapposition of the proximal end of the stent, with an intraluminal signal-rich structure, suggestive of organized stent thrombosis. Stent dilation was performed to maximal recommended diameter, with significant reduction of the malapposed area, as shown by repeated OCT pullbacks. Intracoronary imaging is particularly valuable in PCI of ectatic vessels to guide appropriate stent sizing and avoid stent malapposition. OCT, thanks to its superior spatial resolution in comparison with other intravascular imaging techniques, provides advantages for stent optimization and evaluation of stent failure causes. However, its limited imaging area and possible incomplete blood clearance may limit its usefulness in severely ectatic vessels.