Honeycomb-like appearance on optical coherence tomography of the right coronary artery.

A 37 yr old diabetic male[†], was admitted to the department of Cardiology, Yashoda Hospitals, Hyderabad, India, with chest pain for 15 days. Cardiac evaluation revealed a diagnosis of a silent inferior wall myocardial infarction. Coronary angiography showed significant stenosis with irregular filling defect of the mid-segment of the right coronary artery (RCA). The differential diagnosis of spontaneous coronary artery dissection or recanalized thrombus was suspected (Fig. 1A and B).

Fig. 1

Coronary angiography showed an irregular filling defect with haziness in the middle segment of the right coronary artery (dashed rectangle, Panel A; zoomed view, Panel B). Motorized pullback tracing of optical coherence tomography, (C) cross-sectional and (D) longitudinal view between two solid horizontal white lines in the right coronary artery from middle to proximal portion showed multiple small channels of varying size in communication with each other. These channels were separated by fibrous septa of high-signal intensity and low attenuation, giving honeycomb-like appearance, which is characteristic of recanalized thrombus.

Optical coherence tomography (OCT) showed multiple channels of varying size in communication with each other, separated by septa of high-signal intensity and low attenuation, giving honeycomb-like appearance, which is a characteristic of a recanalized thrombus (Fig. 1C and D). Following percutaneous coronary intervention using drug-eluting stent to RCA, OCT demonstrated complete disappearance of the honeycomb pattern with well-expanded stent (Fig. 2A and B). The fourteen day follow up of the patient was uneventful.

Fig. 2

Post-percutaneous coronary intervention of the right coronary artery after deployment of drug-eluting stent and post-dilatation showed brisk TIMI III flow with no residual stenosis or dissection (Panel A). Optical coherence tomography pullback across the stented segment of the right coronary artery showed well-expanded stent without any residual lesion (Panel B).

OCT has enhanced the diagnostic capability for ambiguous intra-luminal coronary haziness in post-acute coronary syndrome.