Healed Erosion: The Role of Pre-interventional Optical Coherence Tomography in a Patient Clinically Suspected of Having Unstable Angina with Coronary Spasm

Abstract

A 46-year-old man complained of chest pain at rest for the past three months. His symptoms gradually exacerbated and were suspected of being due to unstable angina. A coronary angiogram revealed focal tight stenosis at the proximal left anterior descending coronary artery with gross spastic coronary findings. Optical coherence tomography (OCT) revealed layered low-intensity structures with microvessels and the accumulation of macrophages, which indicated progressive stenosis with multiple-layered organized thrombus caused by coronary erosion. We treated the stenosis using a drug-coated balloon instead of drug-eluting stents. There was no restenosis, and OCT revealed good plaque healing at follow-up. This case suggests that the preinterventional OCT plaque morphology can have a positive impact on the revascularization strategy.

Current Overview of Diagnostic and Treatment Strategies for Ischemia with Non-obstructive Coronary Artery Disease

“…In 2017, Shin et al reported that thrombus and plaque erosion were more common at spasm segments than at nonspasm segments 64) . In (2022) reported layered plaque at spasm sites, which was thought to have healed plaque erosion [66][67][68] . In 2020, Wakabayashi et al reported the accumulation of macrophages only in the segment of focal spasm in a case of myocardial infarction with nonobstructive coronary arteries 69) .…”