A 67-year-old man with ischemic heart disease and severely reduced ejection fraction underwent coronary angiography for a non-ST-elevation myocardial infarction. Angiography revealed a lesion in the proximal left anterior descending (LAD) artery (Video 1). The angiographic appearance of the lesion did not unequivocally identify its nature, the possibilities being a complex dissection or a recanalized thrombus. Optical coherence tomography (OCT) was therefore performed (Figure 1 and Video 2). The unusual image obtained confirmed the presence of multiple lumens in the LAD, apparently following recanalization of a thrombus. Angioplasty of the LAD was accordingly performed and a drug-eluting stent was placed, with an excellent final result (Videos 3 and 4).
Thrombus recanalization can sometimes give rise to angiographic images of considerable complexity, suggesting etiologies that pose greater technical challenges, such as complex dissections. Intracoronary imaging methods such as OCT can clarify the nature of such lesions and enable appropriate treatment, avoiding technically more complex approaches that could potentially have iatrogenic consequences.
Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.
Confidentiality of dataThe authors declare that no patient data appear in this article.
Right to privacy and informed consentThe authors declare that no patient data appear in this article.
Conflicts of interestThe authors have no conflicts of interest to declare.
Please cite this article as: Nobre Menezes M, Francisco ARG, Duarte JA, Canas da Silva P, Pinto FJ. Uma descendente anterior com muitos lúmenes. Rev Port Cardiol. 2017;36:395–396.
