Nicolas Amabile, MD, PhD
Institut Mutualiste Montsouris , Paris, France & CHT Gaston Bourret, Noumea, New Caldeonia
A 60 year-old woman is referred to our center for coronary angiography
Cardiovascular risk factors : age, familial history of coronary artery disease
She suffered from a typical anginal pain one month before (undetermined duration) but she was not seen by a physician at this moment. She also reported recurrent mild chest pain following the initial episode.
She was finally examined by a cardiologist who observed R waves abrasion in anterior leads on EKG and antero-septal hypokinesia on TTE.
Coronary angiography is provided
Although the clinical presentation was suggestive of a semi-recent acute coronary syndrome, the angiography did not show any significant severe stenosis. However, a discrete heterogeneity was observed in proximal LAD : an OCT analysis was thus decided.
OCT revealed the presence of a short double lumen structure located in the proximal LAD
Potential diagnoses included spontaneous localized coronary artery dissection or spontaneously recanalized semi recent thrombosis (“lotus root”).
The medical history of the patient, the presence of an underlying mild lipid atheromatous plaque, the 3 layers that could be observed in both channels evoked the thrombosis option.
The lesion was fixed by PCI and a 3.0 x 18 mm everolimus eluting stent implantation