Thrombotic complication during intracoronary imaging

Abstract

Intracoronary imaging with intracoronary ultrasound and coherence tomography is often used in the follow-up of coronary stent implantation. The present case shows an infrequent complication of these procedures, suggesting our continued attention to the selective use of these invasive procedures.

Fig. 1

a IVUS imaging shows in-stent thrombosis in the bifurcation stent of the left anterior descending artery and first diagonal branch. b OCT imaging shows thrombus in the proximal LAD

Fig. 2

a Angiogram immediately after second IVUS and OCT pullbacks confirmed thromboembolism with subtotal occlusion of the proximal LAD, in-stent thrombosis in the LAD stent and blockage of the first diagonal branch (arrow). b Final angiogram following thrombus aspiration, balloon dilatation and administration of GP IIb/IIIa blockers shows recovery of normal flow without visible thrombi

Fig. 3

Macroscopy of the aspirate (a) shows both red and white thrombus. Histology (b–e) confirms the presence of fresh thrombus containing fields of erythrocytes (Er) and platelets (Pl). The resorcin-fuchsin stain in e (HE in d, detail of c) shows that the tissue does not contain collagen and indicates absence of neointima