Early progression of mimic calcified nodule in patient on hemodialysis
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IMAGES IN CARDIOVASCULAR INTERVENTION
Early progression of mimic calcified nodule in patient on hemodialysis Daijiro Tomii1 · Kazuyuki Yahagi1 · Masahiko Asami1 · Kota Komiyama1 · Jiro Aoki1 · Kengo Tanabe1 Received: 20 August 2019 / Accepted: 2 February 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
A 70-year-old man on hemodialysis (HD) presented with stable angina pectoris and coronary angiography revealed intraluminal filling detects in the proximal right coronary artery (RCA) (Fig. 1A, Suppl Video 1). He underwent percutaneous coronary intervention (PCI) in the middle RCA 15 years earlier. Thereafter, PCI was performed for the instent restenosis 6 months earlier, and intraluminal filling detects were not observed [Fig. 1B (pre-PCI), Fig. 1C (postPCI)] and he had continued dual antiplatelet therapy. Optical coherence tomography (OCT) demonstrated the lesion with thrombus protruding into the lumen which was similar to the findings of calcified nodule (CN) (mimic CN) (Fig. 1D, Suppl Video 2). After pre-dilatation with a non-compliant balloon, the lesion was treated with a drug-eluting stent. Previous studies noted CN was more frequently located in the ostial or middle RCA and HD was associated with the presence of CN [1]. The formation of CN may be associated with mechanical factors, such as a torsional stress and
hinge motion of coronary artery might break the calcium sheet [2]. In the current case, we supposed that the mimic CN had mainly comprised thrombus, because it was easily expanded, in contrast to a pathological CN that includes nodular calcification [2]. In addition, it is challenging to discriminate pathological CN from mimic CN by OCT alone. Mimic CN might be induced by injury from the PCI procedure especially manipulating the guiding catheter 6 months earlier as the tip of the guiding catheter was located at the site of mimic CN (Fig. 1C-2). The progression of mimic CN in the current case was more rapid (
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