Honeycomb-like appearance on optical coherence tomography in right coronary artery

Excerpt

A 37-year-old female came with history of palpitation since one year. Patient was a known case of diabetes mellitus. She had a history of acute inferior wall myocardial infarction 2 years back for which she received streptokinase thrombolytic therapy at the dose of 1.5 million IU. After thrombolysis, she was started on dual antiplatelet therapy aspirin, clopidogrel along with atorvastatin, betablocker and enalapril. In past one year, she developed two episodes of palpitation for which she was DC cardioverted at another hospital. During palpitation, ECG was suggestive of ventricular tachycardia with right bundle branch block morphology with right axis deviation whereas during sinus rhythm, QS complex in lead II, III, avF was present. On 2D Echocardiography, hypokinesia of inferior, inferoseptal, posterior wall was noted and left ventricular ejection fraction was found to be 50%. Coronary angiography showed multiple linear irregular filling defect from proximal to middle portion of the right coronary artery (RCA) with the possibility of either spontaneous coronary artery dissection or recanalized thrombus (Fig. 1, Inlet). Patient underwent CARTO (Biosense Webster, Diamond Bar, CA, USA) guided 3D electroanatomical mapping and ablation of scar related ventricular tachycardia. Optical coherence tomography (OCT) from middle to proximal portion of the RCA showed multiple small channels of varying size in communication with each other (Fig. 1, Panel a–f, Video 1). These channels were separated by septa of high signal intensity and low attenuation giving honeycomb-like appearance which is characteristic of recanalized thrombus. Percutaneous coronary intervention was done through right femoral artery. Using 6F Judkins right 3.5 coronary catheter (Cordis Corporation), RCA was hooked. Predilatation was done with 2 × 12 mm Sprinter^® Legend RX semicompliant Balloon (Medtronic Inc. USA) following which drug eluting stent, Taxus Liberte (Boston scientific, Natick, Massachusetts) Paclitaxel-Eluting stent of size 3.5 × 38 mm in proximal RCA and 3.0 × 38 mm in distal RCA was deployed. Post dilatation was done with 3.5 × 38 mm NC Sprinter™ noncompliant balloon (Medtronic Inc. USA). Post dilatation TIMI 3 flow was achieved. In recanalized thrombus, angiography findings like multiple irregular filling defects and intraluminal haziness are not specific and difficult to differentiate from spontaneous coronary artery dissection. Better resolution of OCT clearly shows honeycomb-like or cheese-like appearance, which is characteristic of recanalized thrombus [1, 2]. …