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A 56 year old Japanese woman was referred to our hospital because of bradycardia and dyspnoea. She had a 30 year history of corticoid treatment and haemodialysis for systemic lupus erythematosis. Her coronary risk factors included hyperlipidaemia and diabetes mellitus two years previously. An ECG revealed first degree atrioventricular block, incomplete right bundle brunch block, and inverted T wave in leads V2–6. She was diagnosed with an anteroseptal myocardial infarction.
Cardiac catheterisation was performed at 14 days after admission. The coronary angiogram revealed no significant stenosis, however the proximal segment of the left anterior descending artery (LAD) had an approximately 5 cm length braid-like lesion (panel A). Angioscopy was undertaken with a 4.5 French catheter advanced proximally to the LAD through a guidewire under fluoroscopy. After equipping with an occlusive cuff for low pressure inflation, a porous vessel surrounding white smooth intima without thrombus was observed at angioscopy (panel B).
Intravascular ultrasound imaging was performed with a 2.9 French, 20 MHz catheter in the LAD from the distal to the proximal lesion. Multiple channel formation was demonstrated in the lumen of the native coronary artery lesion (panel C). The structure of the partition comprised hard tissue, including calcification.
It has been suggested that braid-like lesions are caused by thrombosis and recanalisation during the course of arteritis. This is the first report of a braid-like lesion observed by angioscopy and intravascular ultrasound imaging in a patient with systemic lupus erythematosis.