A honeycomb-like structure in the left anterior descending coronary artery treated using a scoring device and drug-eluting stent implantation: a case report

Abstract

BackgroundA honeycomb-like structure in the coronary artery is rarely diagnosed by intracoronary ultrasound or optical coherence tomography. Further, its structural mechanisms and response to interventional therapy remain unknown.Case presentationA 59-year-old Japanese man was referred to our hospital because of acute decompensated heart failure with rapid atrial fibrillation. After receiving anticoagulant therapy, a coronary angiogram revealed a braid-like appearance and an intracoronary ultrasound image confirmed a honeycomb-like structure in the mid left anterior descending coronary artery. We inserted two guide wires into different partitions. Although a balloon angioplasty with a scoring device could not completely fenestrate these partitions, a stent implant was able to completely compress the structure easily.ConclusionsThe honeycomb-like structure of the left anterior descending coronary artery in our patient was suspected to be because of recanalization of a cardiogenic embolism. This structure may have been composed of relatively hard tissues, but was easily compressed by a stent implantation.

Diagnosis and Management of Spontaneously Recanalized Coronary Thrombus Guided by Optical Coherence Tomography ― Lessons From the French “Lotus Root” Registry ―

“…It can thus confirm a diagnosis of SRCT when angiography is ambiguous. 10 OCT indicated lumen reduction between 20% and 93%, but there was no clear association with stenosis severity or coronary flow. A total of 94% of lesions on OCT were potentially clinical significant (e.g., associated with symptoms of angina or dyspnea), illustrating the poor correlation between lumen area on OCT and hemodynamic impact on FFR.…”

Optical Coherence Tomography for In Vivo Identification, Characterization and Optimal Treatment of Spontaneous Recanalization of Coronary Thrombus

“…The diagnosis becomes possible only by intravascular imaging. The reported angiographic aspect was described as braided in 24 cases (10,16,25,30), as haziness in 18 cases (2, 3, 10, 11, 14, 15, 17, 19-22, 24, 27, 28, 31, 32), as pseudodissection in 15 cases (3,10,13,25) and as occlusions in 5 cases (10,12,18,23,29). Our study shows that only 14.3% of the CA suspected SRCT cases (4 out of 28) were truly OCT confirmed SRCT.…”

“…SRCT were identified, in our study, as culprit or non-culprit lesions for ACS patients. Data from the literature show that the 62 SRCT lesions may be asymptomatic -20 cases (10-12, 20, 22, 26, 28) or symptomatic, associated with stable CAD -23 cases (2,10,13,17,20,21,24,25,(29)(30)(31)(32), UA -5 cases (2,18,27) or acute STEMI -12 cases (2,10,14-16). Other two cases had an undeclared clinical condition (3,23).…”

“…OCT was the only SRCT imaging method for our study, as it was for 56 of the 62 cases reported in the literature (2, 10-12, 14-23, [26][27][28][29]31). IVUS was used in 3 cases (3,24,25), while both OCT and IVUS were used in other 3 cases (13,30,31). Terms used for SRCT description were "honeycomb-like structure" -13 cases (14-17, 19-22, 25-28, 31), "lotus root structure" -38 cases (3, 10, 12, 23, 30, 32), "swiss cheese structure" -8 cases (2,18,25) and SRCT in only 3 cases (11,13,24).…”

Honeycomb-like structure in the right coronary artery treated with a drug-eluting stent: a case report and literature review

“…In total, 20 studies were evaluated. 1 – 20 The diagnosis of HLS was based on coronary intravascular imaging modalities such as intravascular ultrasound and OCT. OCT is the preferred tool with which to demonstrate detailed structures because of its high spatial resolution (10–15 µm). HLS could be found in all three epicardiac arteries without significant territory dominance.…”