Calcified nodule: a double paradox on coronary imaging

A 75-year-old man presented with stable effort angina and normal cardiac biomarkers 10 years after the implantation of two bare metal stents in the proximal right coronary artery. Coronary angiography revealed a moderate lesion on the left anterior descending coronary artery, diffuse distal disease and good results of the two stents. However, a minor, intraluminal filling defect was detected in the segment between the two stents (Appendix Figure 1, Moving image 1). Optical coherence tomography (OCT), with the novel “co-registration” technique, confirmed excellent results in the two stents, nicely covered by a mild layer of homogeneous neointima. However, OCT demonstrated a bright, finger-like ...