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Hazy filling defect on coronary angiography: insights from optical coherence tomography
  1. Umair Hayat1,2,
  2. Muhammad Asrar ul Haq1,2,
  3. Peter Barlis1,2
  1. 1Faculty of Medicine, Dentistry & Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
  1. Correspondence to Professor Peter Barlis, Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, 176 Cooper Street, Epping, VIC 3076, Australia; pbarlis{at}unimelb.edu.au

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Clinical introduction

A middle-aged patient with previous stent to the left circumflex artery (LCx) 12 months before suffering from angina, now presented with acute-onset severe retrosternal chest pain with an ECG showing ST-elevation in the precordial leads (see online supplementary figure S1). He underwent emergency coronary angiography, which showed normal flow in all arteries and a patent LCx stent. The left anterior descending artery (LAD) contained a hazy filling defect in the mid vessel (figure 1A). Following administration of heparin, the filling defect in the mid-LAD resolved (figure 1B). The left ventriculogram showed severe systolic dysfunction involving the mid and apical segments (see online supplementary video 1). This was normal on the previous catheterisation.

Figure 1

Angiographic view of the proximal and mid-left anterior descending artery (LAD) with three corresponding optical …

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