Severe spasm of the left main and spontaneous intramural haematoma: a serial optical coherence tomography study

A 41-year-old woman developed acute myocardial infarction after salbuterol abuse. Coronary angiography showed narrowing of the left main (LM) and of the proximal left anterior descending artery (LAD), and a hazy subocclusion of the mid LAD. Manual and rheolytic thrombectomy were performed without retrieving thrombus and improving flow. Due to haemodynamic instability, we deployed a drug-eluting stent (DES) and performed a first optical coherence tomography (OCT) scan, demonstrating severe spasm of the distal LM, and an extensive intramural haematoma of the proximal LAD, possibly squeezed proximally and distally by stent implantation (Figure 1, top row). We hypothesised intramural haematoma since no ...