Rendered OCT Imaging of an Impressive Stent Malapposition in the Left Main Coronary Artery

J INVASIVE CARDIOL 2019;31(9):E280-E281.

Key words: cardiac imaging, intravascular imaging, unprotected left main coronary artery

A 70-year-old woman was electively admitted to complete revascularization on residual stenosis of the right coronary artery. One month prior, she was hospitalized for non-ST segment elevation myocardial infarction and underwent percutaneous coronary intervention with rotational atherectomy and drug-eluting stent implantation on a very calcific stenosis at the axis of an unprotected left main (LM)/left anterior descending (LAD). A good angiographic result was achieved (Figure 1); intravascular imaging was not performed.

After discharge, the patient was well, except for some episodes of chest pain the night before the current admission. On the scheduled day, elective coronary angiography showed a subacute stent thrombosis at the distal LM; optical coherence tomography (OCT) confirmed a large red thrombus as well as impressive proximal stent malapposition (Figure 2). Postdilation with a 4.0 mm non-compliant balloon was performed according to proximal optimization technique. A good angiographic result was achieved, with OCT showing complete stent apposition (Figure 2). Follow-up was uneventful.

Our case emphasizes the need to use intravascular imaging to optimize stent implantation in the LM. Despite recommendations, intravascular imaging is still widely under-utilized. The recently developed stent apposition OCT software (Optis Stent Optimization; Abbott Vascular) confirmed its usefulness in optimizing stent implantation in an unprotected LM.

From the Unità Operativa Complessa di Cardiologia, Ospedale San Francesco, Nuoro, Italy.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 30, 2019.

Address for correspondence: Dr Pierluigi Merella, Ospedale San Francesco, Unità Operativa Complessa di Cardiologia, via Mannironi 1, Nuoro, Italy. Email: pierluigi9@hotmail.it