Utility of 3D-OCT Imaging With Angiographic Co-Registration in Acute Coronary Syndrome With Normal or Near-Normal Coronary Arteries

J INVASIVE CARDIOL 2017;29(7):E84-E85.

Key words: acute coronary syndromes, cardiac imaging

A 49-year-old male smoker was admitted with chest pain and electrocardiographic T-wave inversion in the anterior chest leads and elevated levels of biomarkers of myocardial damage. Transthoracic echocardiography revealed anteroapical hypokinesis.

Coronariography showed normal coronary arteries. Therefore, based on electrocardiographic and wall-motion abnormalities, we selected the left anterior descending artery as the cause of the acute coronary syndrome and coronary imaging was performed.

Three-dimensional optical coherence tomography (3D-OCT) with angiographic co-registration was performed and an ulcerated small plaque covered by thrombus was observed (Figures 1-3; Videos 1-2). The amount of thrombus was not excessive and the minimal luminal area was 5.62 mm², so a conservative management strategy was selected. The patient was asymptomatic at 6-month follow-up exam.

The OPTIS integrated system (St. Jude Medical) is a new technology allowing the online co-registration of OCT images with the angiogram in the catheterization laboratory.¹ Additionally, 3D navigation can be performed.^2,3 This integration of OCT information on an angiographic roadmap could find broad application in the characterization of substrates causing acute coronary syndromes with normal or near-normal coronary arteries. The utility of OCT with co-registration for the guidance of percutaneous coronary intervention could be considerable in the management of these patients.

References

1.    van der Sijde JN, Guagliumi G, Sirbu V, et al. The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography. EuroIntervention. 2016;12:855-860.

2.    Teeuwen K, Zwart B, van Werkum JW, Joner M, ten Berg JM. 3-dimensional optical coherence tomography imaging in early coronary stent thrombosis. JACC Cardiovasc Interv. 2011;4:256-257.

3.    Camacho Freire SJ, León Jiménez J, Gómez Menchero AE. Metallic stent optimization in dedicated bifurcation stent assessment. Rev Esp Cardiol (Engl Ed). 2017;70:496. Epub 2016 Oct 24.

From the Cardiology Department, University Hospital Juan Ramón Jiménez, Huelva, Spain.

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 November 30, 2016.

Address for correspondence: Santiago J. Camacho Freire, MD, Ronda Norte S/N Secretaria de Hemodinámica, 1st floor, University Hospital Juan Ramón Jiménez,  21005 Huelva, Spain. Email: navallana@hotmail.com