Severe Coronary Spasm Induced by OCT Wire. There Are No Innocuous Procedures

J INVASIVE CARDIOL 2010;22:385

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We present the case of a 64-year-old male who underwent cardiac catheterization because of a positive stress test. No severe narrowings were visible in his left coronary system. His right coronary artery (RCA) (Figure 1) had two moderate narrowings located at the proximal and mid segments (arrowheads) and an image showing plaque ulceration at the distal segment. Evaluation with optical coherence tomography (OCT) of the RCA was proposed and performed using the Imagewire imaging catheter and the M2x Coronary Imaging System (LightLab Imaging, Westford, Massachusetts). The initial evaluation revealed a luminal area of 6 cm2 (Figure 1B) at the level of the moderate narrowing of the mid segment. During the withdrawal of the OCT wire, the patient complained of chest pain and ST-segment elevation was registered on electrocardiographic monitoring. OCT imaging and conventional fluoroscopy demonstrated severe coronary vasospasm (Figures 2A and B) at the atherosclerotic plaque of the mid segment. It was completely resolved with the use of an intracoronary injection of nitrate (Figure 3). OCT is a catheter-based imaging technology that has been demonstrated to be a very useful intracoronary diagnostic tool with few complications related to its application. Coronary vasospasm induced by an OCT wire is an unusual complication of this technique that has not been reported in the main series of OCT safety evaluation in more than 450 patients.1

Reference

1. Barlis P, Gonzalo N, Di Mario C, et al. A multicentre evaluation of the safety of intracoronary optical coherence tomography. Eurointervention 2009;5:90–95.

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From the Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain. The authors report no conflicts of interest regarding the content herein. Manuscript submitted January 26, 2010, provisional acceptance given February 17, final version accepted March 2, 2010. Address for correspondence: Dr. David Dobarro, Cardiology Department, 1ª Floor, La Paz University Hospital, 28046, Madrid, Spain. E-mail: daviddobarroperez@hotmail.com