• Hiroki Okabe, Shinjo Sonoda, Yutaro Naka, Koshi Setoyama, Konosuke Inoue, Toshiya Miura, Reo Anai, Yuki Tsuda, Masaru Araki, and Yutaka Otsuji.
• The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan.
• Intern. Med. 2021 Jul 15; 60 (14): 2241-2244.

AbstractA 46-year-old man complained of chest pain at rest for the past three months. His symptoms gradually exacerbated and were suspected of being due to unstable angina. A coronary angiogram revealed focal tight stenosis at the proximal left anterior descending coronary artery with gross spastic coronary findings. Optical coherence tomography (OCT) revealed layered low-intensity structures with microvessels and the accumulation of macrophages, which indicated progressive stenosis with multiple-layered organized thrombus caused by coronary erosion. We treated the stenosis using a drug-coated balloon instead of drug-eluting stents. There was no restenosis, and OCT revealed good plaque healing at follow-up. This case suggests that the pre-interventional OCT plaque morphology can have a positive impact on the revascularization strategy.

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