Author + information
- Received March 10, 2013
- Revision received April 7, 2013
- Accepted April 16, 2013
- Published online December 10, 2013.
- Fernando Alfonso, MD,
- Nieves Gonzalo, MD,
- Iván Nuñez-Gil, MD and
- Camino Bañuelos, MD
A 76-year-old man admitted for an acute coronary syndrome showed on angiography diffuse coronary calcification and mild lumen irregularities in the proximal left anterior descending and mid left circumflex coronary arteries. Optical coherence tomography revealed preserved coronary lumen at all segments. No features consistent with thin- or thick-cap fibroatheromas, ruptured plaques, or erosions were detected. However, a massive calcification of the left anterior descending and left circumflex coronary artery was recognized. The pattern of calcification was rather unique, involving the entire vessel circumference (ranging from 120° to 360°) and strikingly superficial, with a characteristic “concave shaped” surface apparently devoid of neointimal coverage (A to F, + = calcium, ∗ = wire artifact). Interestingly, clear images of overlying red luminal thrombus were detected at different locations (arrows). These confined thrombi did not seem to originate from protruding calcified plaques (classical calcified nodules) but rather emerged directly from these superficial, heavily-calcified plaques (A to E). Alternatively, small protruding “bony” nodules might have generated intense posterior shadowing, thus masquerading as red thrombi.
In this patient, optical coherence tomography was able to unravel coronary thrombosis occurring in large, nonprotruding, superficial calcified plaques devoid of significant neointimal coverage. Prolonged dual antiplatelet therapy was recommended.
- Received March 10, 2013.
- Revision received April 7, 2013.
- Accepted April 16, 2013.
- American College of Cardiology Foundation