Crop Circles in Optical Coherence Tomography

J INVASIVE CARDIOL 2021;33(6):E490. 

Key words: cardiac imaging, crop circles, optical coherence tomography

A 57-year-old woman with a history of idiopathic thrombo- cytopenia presented with chest pain and inferior ST-segment elevation myocardial infarction following percutaneous coronary intervention to a distal right coronary artery (RCA) stenosis. A right femoral artery angiogram showed an acute stent thrombosis. After blood flow was restored with intracoronary thrombectomy and balloon angioplasty, optical coherence tomography (OCT) was performed using DragonFly Optis (Abbott Vascular). Unfortunately, it was difficult to advance the catheter beyond the stented segment. On review of the image, there were 2 circular figures resembling “crop circles” extending proximally for several frames (Figure 1).

On removal of the catheter, there were 2 kinks on the distal, soft translucent segment of the catheter distal to the lens marker that caused it to fold onto itself and produce the unusual image (Figure 2). This most likely resulted from failed attempts to deliver the DragonFly Optis catheter through the distal RCA stent into a small-caliber right posterior descending artery. In the future, the DragonFly Opstar imaging catheter may reduce the risk of distal catheter kink with a shorter lens-to-tip distance (23 mm compared with 27 mm). 

Although the “crop circles” image is uncommon, as the use of OCT continues to grow and we continue to learn more about this modality, it will be critical to recognize the full OCT image dataset. 

From the ¹Department of Cardiology, Liverpool Hospital, Liverpool NSW, Australia; and ²Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

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.

Manuscript accepted March 5, 2021.

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

Address for correspondence: Giuseppe Femia, MD, Department of Cardiology, Liverpool Hospital, Elizabeth & Goulburn St, Liverpool NSW 2170, Australia. Email: femia82@gmail.com