Intracoronary dual lumen evaluated by high-vision coronary angioscopy
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IMAGES IN CARDIOVASCULAR INTERVENTION
Intracoronary dual lumen evaluated by high‑vision coronary angioscopy Shinichiro Masuda1 · Takashi Shibui1 · Sho Nagamine1 · Takaaki Tsuchiyama1 · Takashi Ashikaga2 Received: 25 October 2018 / Accepted: 5 December 2018 © Japanese Association of Cardiovascular Intervention and Therapeutics 2018
Case description An 80-year-old man with a history of pacemaker implantation due to atrioventricular block and bare-metal stent implantation at mid-left anterior descending artery (LAD) due to angina pectoris was admitted to our hospital because of silent myocardial ischemia. On admission, his electrocardiogram showed normal sinus rhythm with wide QRS waveform under ventricular pacing, and echocardiogram showed no left ventricular wall motion abnormalities. Coronary angiography demonstrated 75% in-stent restenosis at the mid-LAD (Fig. 1a). Fractional flow reserve (FFR) at the distal LAD revealed low FFR value of 0.63. FFR pullback from distal LAD significantly increased to 0.98 at the proximal LAD, which showed 25% stenosis on coronary angiography; there was no significant pressure gradient at the mid-LAD, which had 75% in-stent restenosis (Fig. 1a, b). To assess the decrease of FFR value at the proximal LAD,
we performed optical frequency domain imaging (OFDI), which revealed an intracoronary wall partition that divided the lumen into two chambers (Fig. 1c). Subsequently, highvision coronary angioscopy ( Forwardlooking®, OVALIS, Osaka, Japan) was performed. Coronary angioscopy clearly demonstrated fibrous wall partition with a red thrombus that was similar to the finding on OFDI (Fig. 1d). In this case, although coronary angiography showed mild stenosis at the proximal LAD, OFDI revealed intracoronary multiple lumens, generally known as “lotus root-like appearance” that have been reported as being possible critical functional stenosis [1, 2]. OFDI was a useful modality in providing two-dimensional information regarding intracoronary dual lumen. Furthermore, coronary angioscopy was performed to confirm precise evaluation under direct vision, and it clearly elucidated the three-dimensional structure. To the best of our knowledge, this is the first report to confirm intracoronary dual lumen evaluated by coronary angioscopy.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12928-018-0561-6) contains supplementary material, which is available to authorized users. * Shinichiro Masuda [email protected] 1
Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2‑34‑10 Ebisu, Shibuya‑ku, Tokyo 150‑0013, Japan
Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
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Fig. 1 a, b White arrowheads indicate 75% in-stent restenosis in the mid-left anterior descending artery (LAD). Fractional flow reserve (FFR) assessment indicates significant increase of FFR value at the proximal LAD with mild stenosis on coronary angiography. Distal FFR of 0.63 increases to 0.98
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