ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography

The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative therapy. Therefore, an optical coherence tomography (OCT) was performed and revealed massive, organized thrombi in the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery. The patient was stabilized after percutaneous coronary intervention. As a mural thrombus often goes undetected by coronary angiography, OCT may prove benefit in HTx patients with myocardial infarction or suspected coronary spasms.

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ST-Segment Elevation Myocardial Infarction Due to Optical Coherence Tomography-Detected Coronary Artery Compression Following Supravalvular Pulmonary Artery Patchplasty 18 Years After Switch Procedure

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2018.07.018 ◽

2018 ◽

Vol 11 (18) ◽

pp. e149-e151 ◽

Cited By ~ 2

Author(s):

Yasushi Ueki ◽

Alexander Kadner ◽

Christoph Gräni ◽

Lorenz Räber

Keyword(s):

Myocardial Infarction ◽

Optical Coherence Tomography ◽

Coronary Artery ◽

Pulmonary Artery ◽

Optical Coherence ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Optical coherence tomography-guided percutaneous coronary intervention in a patient with an iatrogenic coronary artery stenosis

EuroIntervention ◽

10.4244/eij-d-21-00499 ◽

2021 ◽

Vol 17 (12) ◽

pp. e1007-e1008

Author(s):

Zvonimir Ostojic ◽

Josko Bulum

Keyword(s):

Optical Coherence Tomography ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Coronary Artery Stenosis ◽

Coronary Intervention ◽

Artery Stenosis ◽

Optical Coherence ◽

Percutaneous Coronary

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Abstract 2506: Coronary Spasm Occurs in Coronary Artery with Diffuse Intima Thickeing without Lipd and/or Calcification:Evaluation with Intravascular Optical Coherence Tomography

Circulation ◽

10.1161/circ.118.suppl_18.s_734 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yoshinobu Morikawa ◽

Shiro Uemura ◽

Ken-ichi Ishigami ◽

Tsunenari Soeda ◽

Satoshi Okayama ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Thrombus Formation ◽

Coronary Spasm ◽

Morphological Characteristics ◽

Provocation Test ◽

Optical Coherence ◽

Coronary Syndrome ◽

Intravascular Optical Coherence Tomography

Coronary spasm (CS) plays an important role in the pathogenesis of many kinds of ischemic heart disease. However, morphological characteristics of coronary artery of CS remain unknown. We evaluated 37 patients with coronary spastic angina (CSA) who underwent diagnostic acetylcholine (ACh) provocation test, and 2 acute coronary syndrome patients suspected to have severe CS. The intravascular optical coherence tomography (OCT) was performed after complete dilatation of coronary artery in all patients and additionally performed during ACh-induced CS in 4 patients. Based on the ACh provocation test, 23 patients who developed CS and ischemic ECG changes were diagnosed as coronary spastic angina (CSA), and other 14 patients without CS were referred as CS-negative patients. CS-negative patients were further divided into 2 sub-groups according to the lipid and/or calcification content in coronary arterial wall by OCT findings. Intravascular OCT revealed most coronary segments with ACh-induced CS had homogenous intima thickening, and quantitative OCT analysis showed that CS-positive segments had significantly larger intima area compared with CS-negative segments without lipid and/or calcification (2.73±0.07 vs. 1.36±0.06 mm 2 , P<0.001). By contrast, CS-positive segments had significantly smaller intima area compared with CS-negative segments with lipid and/or calcification (2.73±0.07 vs. 4.51±0.17 mm 2 , P<0.001). During ACh-induced CS, lumen and total vascular area significantly decreased, whereas intima area did not change in comparison with complete vasodilatation. Furthermore, luminal surface of intimal layer formed markedly wavy configuration during CS. In CSA cases with acute coronary syndrome, we observed additional findings of intima injury as erosion and thrombus formation at spasm site. Coronary spasm occurs in coronary artery with diffuse intima thickening without lipid and/or calcification content but not in artery either without intima thickening or with lipid and/or calcification, and coronary spasm sometimes induces intimal injury by itself which may cause acute coronary event.

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