Key result
OCT distinguishes healed SCAD from woven coronary arteries and recanalized thrombus.
Why the study?
Differentiating healed spontaneous coronary artery dissection from woven coronary arteries or recanalized thrombus is challenging due to overlapping angiographic features.
Case Report (n=1)
Intravascular imaging with optical coherence tomography is critical for differentiating angiographically similar lesions such as healed SCAD, woven coronary artery, and recanalized thrombus to guide appropriate management.
BACKGROUND: Differentiating healed spontaneous coronary artery dissection (SCAD) from woven coronary arteries or recanalized thrombus can be challenging. CASE SUMMARY: A 33-year-old man presented with chest pain and was found to have a severe atypical-appearing lesion in the proximal left anterior descending artery. Differential diagnoses included healed dissection, woven coronary, and recanalized thrombus. Coronary computed tomography angiography demonstrated SCAD. Optical coherence tomography revealed extensive lipid plaque, foamy macrophages, cholesterol crystals, and plaque rupture with recanalized thrombus. The patient underwent successful percutaneous coronary intervention, with complete resolution of symptoms. DISCUSSION: Angiographic and computed tomographic features of healed SCAD, woven coronary arteries, and recanalized thrombus can overlap. Optical coherence tomography can differentiate by visualizing dissection flaps, intramural hematomas (SCAD), or small channels within a thrombus. TAKE-HOME MESSAGES: Healed SCAD, woven coronary artery, and recanalized thrombus have resembling angiographic features. Differentiating among them is critical, as the management differs. Intravascular imaging can help.
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Jaramillo-Restrepo et al. (2026) conducted a case report in Atypical-appearing coronary lesion (n=1). Optical coherence tomography was evaluated on Diagnosis and differentiation of the coronary lesion. Optical coherence tomography successfully differentiated an atypical coronary lesion as plaque rupture with recanalized thrombus, guiding successful percutaneous coronary intervention.
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