Optical coherence tomography was used to gain further anatomic insights in a 34-year-old patient suffering from a catheter-induced iatrogenic coronary artery dissection. This technique enabled precise recognition of the coronary entry door, true and false lumen and also assessing the characteristics, location, extent and length of the intima-medial dissection. After the intervention, optical coherence tomography readily visualised appropriate stent expansion and apposition, detected a minor residual intramural haematoma and ruled out residual edge-dissections.
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We present the case of a patient admitted in 2002 with NSTEMI with three vessel disease. PCI of LAD, RCA and OM was undertaken with four sirolimus eluting-stents with immediate excellent results. Aspirin and clopidogrel were taken for 12 months. An angiogram six months later showed patent stents, scintigraphy in 2008 was normal. In 2009, the patient stopped aspirin for a week. He then presented with acute stent thrombosis of all previously placed DES. Unfortunately, the patient died despite immediate PCI. This case underlines the questions concerning delayed endothelialisation of DES and long term compliance with antiplatelet agents.
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