Intravascular Imaging-guided Percutaneous Coronary Intervention for Braid-like Coronary Stenosis in a Patient with Prior Myocardial Infarction

Abstract

A 77-year-old man was admitted to our hospital because of chest oppression on efforts.  He had developed an inferior acute myocardial infarction and had undergone percutaneous coronary intervention (PCI) for the right coronary artery (RCA) 10 years earlier.  Significant stenoses were detected in the proximal left anterior descending artery (LAD), obtuse marginal artery (OM), and proximal RCA by coronary angiography.  The coronary angiography revealed a braid-like stenosis in the proximal RCA. Because his symptoms continued even after PCI for LAD and OM lesions, we performed PCI for the RCA lesion.  OCT revealed the most severe stenosis located proximally and a stenosis with multiple channels located distally.  The proximal stenosis had thick homogeneous and high -intensity septum.  In contrast, the distal stenosis had multiple lumens separated by high-intensity thin septa. On the other hand, IVUS clearly showed that different channels were connected to the different side branches at both edges of the stenosis, and they converged into a single lumen proximally and distally. IVUS and OCT proved beneficial for the evaluation of coronary artery structure with a braid-like appearance. We performed PCI under the guidance of OCT.