Optical coherence tomography to identify the cause of an arrhythmic storm: A case report

Figure 1 Angiography images at presentation. A, B: First angiogram. Arrows show a 50% lesion on the left circumflex artery with a TIMI grade 3 flow in the RAO/caudal view (A) and LAO/caudal view (B). After documentation of transmural ischemia and recurrence of the arrhythmic storm, the second angiogram revealed the same non-occlusive and intermediate lesion highlighted by the arrow in RAO/caudal view (C). RAO: Right anterior oblique; LAO: Left anterior oblique.

Figure 2 Optical coherence tomography performed during the repeated angiogram. A: OCT showing cross-section lumen reconstruction at the level of the plaque rupture. An intraluminal non-occlusive thrombus (+) is visualized. Arrow 1 shows rupture thin-cap fibroatheroma as visualized by the loss of continuity of the normal intima show by Arrow 2; B: OCT longitudinal lumen reconstruction at the mid left circumflex artery level. Arrow 3 highlights both plaque rupture and intraluminal thrombus be just before the bifurcation with the first marginal (asterisk). OCT: Optical coherence tomography.

Figure 3 Angiogram and optical coherence tomography images after percutaneous coronary intervention. A, C: OCT confirming stent expansion and apposition in the cross-sectional (A) and longitudinal (C) lumen reconstruction. Arrow in A highlights good strut apposition to the vessel wall and B is final angiogram. The arrow in B highlights the level of the previous stenosis and the percutaneous coronary intervention success. OCT: Optical coherence tomography.