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Hemodynamic Findings of Spontaneously Recanalized Coronary Thrombus
Abstract: This case presented is a patient with non-ST elevation myocardial infarction with angiographic non-flow limiting linear opacity in coronary artery with fractional flow reserve in ischemic range secondary to recanalized organized thrombus.
J INVASIVE CARDIOL 2012;24(7):368-369
Key words: recanalized thrombus, fractional flow reserve, optical coherence tomography
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Optimal coherence tomography (OCT) is a novel technology that measures near-infrared light reflections and translates them into a two-dimensional image, and has an axial resolution nearly 10-times that of intravascular ultrasound. Spontaneously recanalized intracoronary thrombus appearance has been described with OCT.1,2 How these multiple channels affect coronary flow has not be shown. The case presented is a patient with non-ST elevation myocardial infarction with angiographic non-flow limiting linear opacity in coronary artery with fractional flow reserve (FFR) in ischemic range secondary to recanalized organized thrombus.
Case Report
The patient is a 62-year-old man with hyperlipidemia, who was admitted with acute exacerbation of chronic obstructive pulmonary disease needing mechanical ventilation and support with cardiac pressor. He sustained a non-ST elevation myocardial infarction with peak troponin at 1.2 ng/mL. Echo windows could not be obtained due to lung hyperinflation. After extubation 24 hours later, he underwent cardiac catheterization. Angiogram demonstrated only mild atherosclerosis with non-flow limiting linear opacity in the mid-segment of the 
right coronary artery (RCA), and mildly reduced ejection fraction with inferior wall hypokinesis. The finding was initially thought to represent spontaneous RCA dissection or intracoronary thrombus (Figures 1 and 2) or calcification. A Prestige Plus FFR wire (Volcano Corporation) was passed carefully beyond the linear opacity. There was mild resistance encountered while advancing the body of the wire. FFR was 0.73. To further delineate the opacity, optical coherence tomography (OCT) was 
performed. It revealed a Swiss-cheese like array of multiple small channels, with varied diameter and signal-rich septations, consistent with spontaneous recanalized thrombus (Figures 3 and 4). A Xience V drug-eluting stent (Abbott Vascular) was placed directly, with excellent result by both angiography and repeat OCT. The final FFR was within the normal range at 0.96. To our knowledge, this is the first report that demonstrates FFR findings of a spontaneously recanalized coronary thrombus.
References
- Cho JM, Raffel OC, Stone JR, et al. Spontaneous recanalization of a coronary artery after thrombotic occlusion: in vivo demonstration with optical coherence tomography. J Am Coll Cardiol. 2010;55(12):1274.
- Davlouros PA, Karantalis V, Mavronasciou E, et al. Optical coherence tomography features of late-stage recanalised coronary thrombi. Eurointervention. 2011;5(8):1022-1023.
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From the Department of Medicine, Division of Cardiology, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Sachdeva serves on the speaker’s bureaus for St Jude Medical and Volcano Corporation. The other authors report no disclosures.
Manuscript submitted December 29, 2011 and accepted January 18, 2012.
Address for correspondence: Rajesh Sachdeva, MD, 4300 W. 7th Street, Little Rock, AR 72205. Email: rrsachdeva@gmail.com and rsachdeva@uams.edu
