IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Imaging: Intravascular
Chen Ting Tan1, Alan Fong1
Sarawak Heart Centre, Malaysia1,
After the BMW guidewire crossed the lesion, angiography revealed the “lesion” was a thrombus and it migrated to distal LAD. OCT confirmed plaque rupture with minimum lumen area (MLA) of 4.97mm2
. In view of adequate lumen area and angiography TIMI III flow, we decided to leave the lesion without stenting. Thrombo-aspiration over the distal LAD, yielded some thrombus. IV Tirofiban infusion was commenced for 24 hours. Subsequent Echocardiogram showed LVEF 35.2% with RWMA. After completed ACS treatment for 3 days, he was discharged with aspirin and clopidogrel. A re-look angiogram was done at 1 month showed proximal LAD 30% stenosis and OCT confirmed healed plaque ruptured with MLA of 5.38mm2
. Clinically, he was well no angina, NYHA Class 1 and had no heart failure symptoms. oct_3 Nov 2020 10-44-17.mp4 oct.mp4 ak 2(2).mp4
ACS is a leading cause of death worldwide and plaque rupture accounted for nearly two-third of cases. Optical coherence tomography (OCT) enables us to identify the mechanism of ACS, thereby providing precise and personalized therapy. Erosion study has shown that OCT identified plaque erosion will be benefited from antithrombotic therapy alone without stent implantation. In our case, OCT showed plaque rupture with adequate lumen area had late lumen gain at 1 month without stenting. Therefore, not all the plaque rupture is the same and further study is needed to validate this.