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

Abstract

Background/Aim: Spontaneous recanalization of coronary thrombus (SRCT) is a rare in vivo appearance, with a nonspecific angiographic aspect. The aim of this study was to investigate the importance of optical coherence tomography (OCT) use for SRCT identification, characterization of pathogenic mechanisms and optimal treatment. Patients and Methods: We retrospectively analyzed all patients with angiographic suspicion of SRCT who underwent coronary angiography for suspected coronary artery disease and afterward investigated by OCT imaging. Results: We identified 28 cases with angiographic suspicion of SCRT (0.41% of CA) and confirmed it in 4 patients (0.05% of CA). OCT provided insight about the underlying SRCT mechanism: possible complicated atherosclerotic plaques in two cases and, respectively, spontaneous coronary artery dissection in other two cases. OCT provided accurate lesion assessment and offered optimal PCI materials selection. Conclusion: Besides providing the diagnosis, OCT also improved characterization of SRCT pathogenic mechanisms, in the four confirmed SRCT cases, supporting the role of coronary wall in situ complications, namely dissection of an atherosclerotic plaque or spontaneous dissection of a normal coronary wall.

Optical Coherence Tomography—OCT for Characterization of Non-Atherosclerotic Coronary Lesions in Acute Coronary Syndromes

“…Prevalence of SRCT lesions is believed to be around 0.1% of PCIs, reported in two different studies: 4 cases out of 4302 PCIs [ 10 ] and 33 cases out of 31,500 PCIs [ 38 ]. To date, there are published only 3 studies and 23 cases reports, accounting for a total of 66 cases [ 10 ].…”

“…Prevalence of SRCT lesions is believed to be around 0.1% of PCIs, reported in two different studies: 4 cases out of 4302 PCIs [ 10 ] and 33 cases out of 31,500 PCIs [ 38 ]. To date, there are published only 3 studies and 23 cases reports, accounting for a total of 66 cases [ 10 ]. In the literature, there are few different terms used to describe SCRT lesions: “honeycomb-like structure”, “lotus root structure”, “swiss cheese structure” and “spider web”.…”

“…In the literature, there are few different terms used to describe SCRT lesions: “honeycomb-like structure”, “lotus root structure”, “swiss cheese structure” and “spider web”. The true prevalence of SRCT might be underestimated, due to its angiographic non-specific aspect [ 10 ]. SCRT lesions has apparently a higher prevalence in men [ 10 ].…”

“…The true prevalence of SRCT might be underestimated, due to its angiographic non-specific aspect [ 10 ]. SCRT lesions has apparently a higher prevalence in men [ 10 ].…”

“…The most prevalent coronary lesions are represented by the atherosclerotic plaques, in more than 85% of cases [ 1 ], but there are several other non-atherosclerotic lesions such as spontaneous coronary artery dissection and/or hematoma [ 8 , 9 ] and spontaneous recanalization of coronary thrombus [ 10 , 11 ], which are less common, approximately 5% of cases [ 1 ], but with similar clinical manifestations as well as complications. There are insufficient data regarding the pathological mechanism, true prevalence and optimal treatment of these kind of coronary lesions.…”