Image – Interventional flashlight

DOI: 10.4244/EIJ-D-22-00775

“Lotus root”: a novel optical coherence tomography imaging pattern in spontaneous coronary artery dissection

David del Val1,2, MD, PhD; Teresa Bastante1,2, MD; Fernando Rivero1,2, MD, PhD; Javier Cuesta1,2, MD, PhD; Maria Martinez-Avial1, MD; Fernando Alfonso1,2, MD, PhD

A 48-year-old woman with previous history of hyperthyroidism caused by Graves' disease presented with unstable angina. Three years before, the patient was admitted for a non-ST-segment elevation myocardial infarction. At that time, coronary angiography revealed severe coronary artery tortuosity with an abrupt and diffuse lumen narrowing of the distal left anterior descending coronary artery (LAD) as a result of spontaneous coronary artery dissection (SCAD) presenting as an intramural haematoma (Figure 1A, Moving image 1) with no stenosis in the right coronary artery (RCA) (Figure 1B, Moving image 2). The patient was successfully managed conservatively, and further angiography screening identified stigmas of fibromuscular dysplasia in the right renal artery (Figure 1E).

The current coronary angiogram showed complete healing (restitutio ad integrum) of the distal LAD and a mild stenosis with a small aneurysm (not present in the previous angiogram) in the proximal RCA (Figure 1C, Figure 1D, Moving image 3, Moving image 4). Of note, no classic angiographic findings of SCAD were observed. Nevertheless, along with the characteristic double-lumen pattern (Figure...

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Volume 18 Number 17
Apr 24, 2023
Volume 18 Number 17
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