A 46-year-old male patient, with a 6-month history of angina pectoris, normal electrocardiogram (Supplementary material online, S1), normal left ventricular function (Supplementary material online, S2), underwent coronary angiography. This showed a total occlusion of the mid left anterior descending artery (LAD) with contralateral collaterals (Panels A and B) (Supplementary material online, S3 and S4).
As symptoms were mild, medical treatment (acetylsalicylic acid 80 mg, simvastatin 80 mg, molsidomine 2 mg b.i.d.) and cardiac rehabilitation were recommended in view of limited apical and apical anterior moderate ischaemia on dobutamine stress echocardiography.
Four years later, he presented for recurrent angina with normal left ventricular function. Repeat coronary angiography showed a non-significant smooth lesion of the mid LAD at the level of the former occlusion (Panel C) with TIMI 3 anterograde flow and no visible collaterals (Supplementary material online, S5–S7). Lesion quantitative coronary analysis was performed (Panel D).
Based on the past history, the myocardial fractional flow reserve (FFR) under adenosine infusion was measured in the distal LAD at 0.61, significant for ischaemia, with a pullback jump at the level of the mid LAD lesion (Panel E). Optical coherence tomography (OCT) imaging confirmed a spontaneously recanalized organized coronary thrombus (SROCT) with high-backscattered signal-rich smooth septa dividing the lumen into several communicating cavities creating a ‘Swiss cheese’ aspect. Lesion length was 15 mm (Panel F) (Supplementary material online, S8).
The patient was treated with a 3.0 × 24 mm stent (Supplementary material online, S9 and S10). Final FFR was 0.96. He is asymptomatic with normal maximal bicycle stress test.
Recording FFR and OCT proved the ischaemic functional significance of a SROCT, leading to the correct treatment of an angiographically non-significant LAD lesion.
Supplementary material
Supplementary material is available at European Heart Journal - Case Reports online.
Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance.
Conflict of interest: none declared.
Supplementary Material
Contributor Information
Melissa Vota, Department of Cardiology, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, 322, Rue, Haute, B-1000 Brussels, Belgium.
Panagiotis Xaplanteris, Department of Cardiology, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, 322, Rue, Haute, B-1000 Brussels, Belgium.
Lakhdar Mira, Department of Cardiology, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, 322, Rue, Haute, B-1000 Brussels, Belgium.
Nadia Debbas, Department of Cardiology, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, 322, Rue, Haute, B-1000 Brussels, Belgium.
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