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Multiple plaque morphologies assessed by optical coherence tomography in a patient with acute coronary syndrome
  1. K Toutouzas,
  2. A Karanasos,
  3. C Stefanadis
  1. Correspondence to ktoutouz{at}

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A 64-year-old male patient presented at the emergency department with chest pain. ST-segment depression (1 mm) was present in leads V4–V6, and cardiac troponin was elevated (10.4 ng/ml). He was treated medically, and he did not have any chest pain thereafter. We performed coronary angiography 60 h later, which revealed a proximal lesion in the left circumflex artery with a filling defect and a significant lesion in the obtuse marginal (panel 1). Both lesions were investigated by optical coherence tomography (OCT).

Panel 1

Coronary angiogram of the left coronary artery, demonstrating the sites of OCT image acquisition.

Pullback of the OCT wire was performed in the obtuse marginal branch, and the proximal left circumflex artery and images acquired from sites A–F in panel 1B are presented in panel 2 (GW, guidewire artefact; Ca, calcification; L, lipid pool). panel 2A demonstrates a significant stenosis with fibrous tissue and a lipid pool occupying two quadrants of the cross section. Distally to the minimal lumen site, there was a calcified plaque morphological feature (panel 2B), whereas red thrombus (arrow) was observed at the site of the filling defect (panel 2C). The lesion was covered with white thrombus (arrows) at the minimal lumen site (panel 2D). Panel 2E,F is showing a plaque rupture (arrow) and an adjacent thin-cap fibroatheroma (minimal cap thickness, measured at the location of the white arrows, was 50 μm), respectively. OCT was able not only to identify underlying plaque morphological features but also to detect thrombi of different stages of organisation.

Panel 2

Optical coherence tomography images acquired from sites A–F of panel 1B.


  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the institutional ethics committee.

  • Provenance and peer review Not commissioned; not externally peer reviewed.