Role of Intravascular Imaging for the Diagnosis of Recanalized Coronary Thrombus

Recanalized thrombus (RCT) of coronary arteries is frequently unrecognized in interventional cardiology practice. Intravascular imaging conclusively establishes its diagnosis, which otherwise is often misdiagnosed as fresh thrombus, spontaneous coronary artery dissection , or severe calcification based on angiography , alone. We hereby report our experience of 10 RCT patients, who had the intravascular imaging-guided diagnosis, followed by the successful percutaneous coronary intervention (PCI). It was a retrospective analysis of 10 patients, who had angiographic haziness of the target lesion during PCI, which were found to be RCT on intravascular imaging. Either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) was performed to characterize RCT in 9 and 1 patient, respectively. The mean age was 53 ± 13.1 years, comprising 9 men and 1 woman. Six patients had acute coronary syndrome , while four had chronic stable angina . Coronary angiography revealed ≥ 70% angiographic stenosis, with intracoronary haziness/filling defects which were linear, spiral or braided in appearance. OCT findings in 9 patients include signal-rich, high backscattered septa dividing the lumen into multiple small cavities communicating with each other, giving a “Swiss cheese” or “honeycomb” appearance. Intravascular ultrasound (IVUS) findings in one patient showed multiple cavities filled with blood speckling consistent with recanalized thrombus. All patients underwent successful PCI with image-guided optimization. With the increasing use of intravascular imaging during PCI, RCT is frequently identified. OCT remains the investigation of choice to differentiate it from other similar entities on angiography. • Intravascular imaging of 10 cases of recanalized thrombus and its percutaneous coronary intervention (PCI) being reported. • Coronary lesions with angiographic haziness were classified as veiled, spiral and braided like appearance. • Intravascular imaging could demonstrate multiple intraluminal channels in all the cases suggestive of recanalized thrombus. • Optical coherence tomography could demonstrate classical “Lotus root” or “Honeycomb” appearance of recanalized thrombus. • Successful PCI with drug-eluting stent was performed in all the cases.