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

Figures

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  Figure 1. SCAD in a 47 years old female patient with inferior ST segment elevated myocardial infarction. (A)—OCT—longitudinal view—SCAD—true and false lumen; (B)—coronary angiography of SCAD; (C)—post PCI result with 2 drug eluting stents; (a–d)—OCT—transversal views—SCAD—true and false lumen; (c)—SCAD fenestration (red arrow); (c1)—rich vasa-vasorum network (white arrowheads); (e)—OCT—post PCI result prolapse of intimal flap between stent struts (asterisk).

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  Figure 2. SCAD in a 46 years old female patient with anterior ST segment elevated myocardial infarction. (A)—coronary angiography of SCAD on proximal left anterior descending artery; (B)—OCT—longitudinal view—SCAD—true and false lumen (asterisk); (C)—OCT—3D reconstruction, dissection flap—white arrowhead; (D)—coronary angiography—post PCI result with one drug eluting stent; (a–d)—OCT—transversal views—SCAD—true and false lumen (asterisk); (e,f)—OCT—endoscopic view (dissection flap—white arrowhead, false lumen—asterisk).

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  Figure 3. SCAD in a 41 years old male patient with anterior ST segment elevated myocardial infarction. (A)—OCT—longitudinal view—in wall hematoma (asterisk); (B)—normal coronary arteries on angiography; (a–c)—OCT—transversal views—SCAD—in wall hematoma (asterisk)—dissection entry point (white arrowhead in (b)).

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  Figure 4. SCAD in a 48 years old female patient with non ST segment elevation myocardial infarction. (A)—coronary angiography—borderline proximal left anterior descending artery stenosis; (a–d)—OCT—transversal views—SCAD—in wall hematoma (asterisks) with thrombus on the intimal surface (white arrowhead in (c,d)), with significant lumen reduction, followed by PCI.

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  Figure 5. Multivessel SCAD in a 45 years old female patient with inferior ST segment elevated myocardial infarction. (A)—coronary angiography—SCAD (white arrowheads) on left circumflex artery (a) and obtuse marginal artery (OM); (B)—coronary angiography—long SCAD (white arrowheads) on righ coronary artery (RCA); (1,2)—SCAD PCI strategy—distal and proximal stent implantation to stop progression of the dissection; (C,D)—very good post PCI result on RCA and OM; (E,F)—right and left renal arteries with FMD aspect (white arrows). Due to continuous intense angina, we did not perform OCT.

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  Figure 6. SRCT in a 43 years old female patient with unstable angina. (A)—coronary angiography—braided filling defect on mid left anterior descending artery; (B)—detailed angiographic view; (C)—OCT—longitudinal view of SRCT (between the red arrowheads); (a–e)—OCT—transversal views of SRCT with signs of atherosclerosis: atheroma infiltration (asterisk), hypervascularization (white arrowheads) and proteoglycan-rich tissue (white arrows). Drug eluted stent implantation was performed.

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  Figure 7. SRCT in a 41 years old male patient with anterior ST elevation myocardial infarction. (A)—coronary angiography—braided filling defects on proximal and mid left anterior descending artery; (B)—detailed angiographic view; (C)—OCT—longitudinal view of SRCT; (D)—OCT—3D reconstruction longitudinal view of SRCT; (a–d) OCT—transversal views of SRCT with no signs of atherosclerosis, with possible SCAD etiology. Conservative treatment was applied, due to the scarred myocardium.