Optical coherence tomography evidence of endothelial erosion as a cause of ST-segment elevation myocardial infarction

• Published in: Journal of cardiovascular medicine (Hagerstown, Md.) Vol. 14; no. 5; p. 393
• Main Authors: Fineschi, Massimo, Sirbu, Vasile, D'Ascenzi, Flavio, Carrera, Arcangelo, Barbati, Riccardo, Mondillo, Sergio, Pierli, Carlo
• Format: Journal Article
• Language: English
• Published: United States 01.05.2013
• Subjects: Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary Artery Disease - therapy; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - etiology; Coronary Thrombosis - pathology; Coronary Thrombosis - therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Endothelium, Vascular - pathology; Female; Humans; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Predictive Value of Tests; Tomography, Optical Coherence
• ISSN: 1558-2035
• DOI: 10.2459/JCM.0b013e32835f4e85

High-resolution intracoronary imaging provided relevant insights into the field of pathophysiology of acute coronary syndromes (ACS). Human autopsy studies have shown that endothelial erosion may lead to intravascular thrombosis and acute myocardial infarction. We report the case of a 51-year-old woman presenting with ST-segment elevation ACS. In this patient, frequency domain optical coherence tomography (FD-OCT) was performed into the infarct-related artery, showing in-vivo findings suggestive of endothelial erosion, associated with no flow-obstructing luminal thrombus. In this rare case, endothelial erosion, and subsequent thrombosis, in the proximal third of the artery has probably caused embolization and thrombotic occlusion in the mid third. FD-OCT allowed us to obtain a rare in-vivo image of endothelial erosion, providing relevant insights into the setting of ACS.