A bi-directional assessment of spontaneous coronary artery dissection by three-dimensional flythrough rendering of optical coherence tomography images

Abstract

A 71-year-old woman was admitted to our hospital due to unstable chest pain. Coronary angiography demonstrated a complex eccentric lesion with 80% narrowing of the right coronary arterial lumen (Panel A). Intravascular optical coherence tomography (IV-OCT) revealed typical characteristics of spontaneous coronary artery dissection (SCAD), such as proximal intimo-medial tear (Panel Aa), false lumen (Panel Ab), and intramural hematoma (Panel Ac, asterisk). A zotarolimus-eluting stent (Resolute Integrity, Medtronic, Santa Rosa, CA, USA) was deployed at the lesion. Post-stenting angiography showed completely restored luminal patency (Panel B) and an IV-OCT confirmed the well-covered proximal dissected site (Panel Ba′), obliteration of the false lumen without compromising the side branch (Panel Bb′), and compression of the intramural hematoma (Panel Bc′, asterisk). Three-dimensional (3D) reconstruction of the OCT images allows clear visualization of dissected flap (Panel Ad) and its complete obliteration following stenting (Panel Bd′). A fly through 3D rendered OCT image in a distal to proximal direction which is conventional direction in routine practice, dissected lesion was hardly identified (Panel C, arrow heads: dissection flap, Supplementary material online, Video S1). In contrast, in a proximal to distal direction, intuitive comprehension of spatial structure of the dissected lesion was possible at a glance (Panel D, arrow heads: dissection flap, Supplementary material online, Video S2). This bi-directional assessment of SCAD using a fly through 3D rendered OCT image might be useful for clinicians to evaluate the characteristic of coronary dissection and would provide valuable information for lesion-specific treatment.