Optical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction

Abstract

HomeCirculationVol. 116, No. 14Optical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBOptical Coherence Tomography in the Setting of an Acute Anterior Myocardial Infarction Ravinay Bhindi, Shahzad M. Munir and Keith M. Channon Ravinay BhindiRavinay Bhindi From the Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Search for more papers by this author , Shahzad M. MunirShahzad M. Munir From the Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Search for more papers by this author and Keith M. ChannonKeith M. Channon From the Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Search for more papers by this author Originally published2 Oct 2007https://doi.org/10.1161/CIRCULATIONAHA.107.722769Circulation. 2007;116:e366–e367An 82-year-old man presented with an acute anterior myocardial infarction and was treated with intravenous reteplase with successful reperfusion. Forty-eight hours later, however, he developed further chest pain and ST-segment elevation. He was referred for salvage percutaneous coronary intervention.The left anterior descending artery was completely occluded proximally (Figure, A) with no detectable collateral flow, and the remainder of the coronary circulation showed diffuse nonsignificant disease. The left anterior descending artery was engaged with a JL4 guide catheter and wired with a Whisper J wire. The lesion was predilated with a 1.5-mm noncompliant balloon that restored flow to the left anterior descending artery and demonstrated a tight culprit lesion in the left anterior descending artery (Figure, B). This was then imaged with optical coherence tomography (OCT), which was facilitated by bolus contrast injection instead of proximal vessel occlusion. Panel C of the Figure demonstrates the composition of the plaque, which was disrupted with fibrocalcific material in the wall and thrombus in the vessel lumen. The lesion was then further dilated with a 2.5/12-mm balloon, stented with a 3.5/12-mm drug-eluting stent, and finally postdilated with a 3.5/9-mm balloon with an excellent angiographic result (Figure, D). OCT was then performed with proximal balloon occlusion at the end of the case, which showed a widely patent vessel, good stent apposition, and no luminal thrombus (Figure, E). Download figureDownload PowerPointA, Coronary angiography demonstrates a totally occluded left anterior descending artery proximally (arrow). B, After predilatation of the left anterior descending artery, the culprit lesion is identified (arrow). C, OCT of the lesion demonstrates a stenosed lumen with a predominantly fibrocalcific plaque (L), which shows evidence of disruption and intraluminal thrombus (arrow). D, Angiographic image after stent deployment (arrow) shows a widely patent vessel. E, OCT after stent deployment demonstrates a widely patent lumen with no intraluminal thrombus and good stent apposition (arrow).OCT is a novel, high-resolution, intravascular imaging modality that provides “optical biopsies” of the vascular wall.1,2 Because blood interferes with the imaging capabilities of the OCT probe, vessel occlusion followed by saline injection is generally performed to permit viewing. An alternative strategy is concurrent imaging during the injection of a contrast bolus to displace blood; this alternative technique was adopted in the present case during the initial sequence of imaging, when blood flow was diminished as a result of the recently ruptured plaque. Adequate images were obtained with no significant delay using this procedure. The present case shows the OCT images of a ruptured plaque detected during salvage percutaneous coronary intervention after an anterior myocardial infarction, which was performed in a hemodynamically stable patient with failed thrombolysis, to characterize the culprit lesion. Such an approach could potentially be used to broaden the application of OCT.DisclosuresNone.FootnotesCorrespondence to Dr Ravinay Bhindi, Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom. E-mail [email protected]References1 Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002; 106: 1640–1645.LinkGoogle Scholar2 Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, Shishkov M, Houser S, Aretz HT, Halpern EF, Bouma BE. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation. 2005; 111: 1551–1555.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Lee R, Antoniades C, Adlam D and Channon K (2012) Treatment of recurrent vein graft “stent-in-stent” re-stenosis guided by optical coherence tomography, International Journal of Cardiology, 10.1016/j.ijcard.2011.08.007, 156:1, (e20-e21), Online publication date: 1-Apr-2012. October 2, 2007Vol 116, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.722769PMID: 17909111 Originally publishedOctober 2, 2007 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsImagingMyocardial Infarction