Findings of optical frequency domain imaging and coronary angioscopy in a lesion with spontaneous recanalization identified by serial coronary angiography

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A lotus root-like appearance was occasionally found by optical frequency domain imaging (OFDI) during percutaneous coronary intervention. The mechanism of a lotus root-like appearance has not been fully understood yet 1–3. Coronary angioscopic findings of the lesion have not been reported yet.
A 51-year-old patient was admitted to our hospital for acute myocardial infarction. Emergency coronary angiography showed two-vessel occlusion both in the left anterior descending artery (LAD) without visible collateral circulation and in the right coronary artery (RCA) with good collateral from the left circumflex artery. On angiography, thrombus was observed in the LAD, which was considered the culprit lesion. The occlusion of the RCA was believed to be a chronic total occlusion lesion. Then, we performed primary percutaneous coronary intervention for the LAD. Successful reperfusion therapy was achieved.
Six years later, follow-up coronary angiography showed that previously occluded proximal RCA was spontaneously recanalized with moderate stenosis (Fig. 1). OFDI showed plaque rupture proximal to the recanalized lesion and multiple channels communicating with each other at the mid portion, which was called a lotus root-like appearance. Coronary angioscopy showed that the lesion was occupied with thrombus. A part of the white thrombus was moving to and fro, synchronized for a heartbeat.
This is the first report of coronary angioscopic findings in a lesion with spontaneous recanalization identified by serial coronary angiography. These findings suggested that a lotus root-like appearance by OFDI was an image of a lesion with spontaneous recanalization after thrombotic occlusion.

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