Shinya Hata

1
OCT imaging can help clarify the pathogenesis of
AMI with complete occlusion at 5 months after
onset.

• Shinya Hata

Division of Cardiology, Cardiovascular Center,
Teine Keijinkai Hospital
TEL [phone] FAX [phone]
Shinya-hata19820619_at_hotmail.co.jp
2
HPI

• A 37 y.o. male with history of smoking
• Diagnosis inferior AMI and paroxysmal AF
• Emargent CAG seg 3 100 (1VD) others normal
• Emargent PCI seg 3 100?0 TIMI 3
  
• (thrombus aspiration
  only)
• IVUS mural thrombus() positive remodeling(-)
• massive plaque(-)
• OCT mural thrombus() dissection(-)
• ruptured plaque was not found
• Pathogenesis of arterial occlusion at onset
• embolism caused by AF or plaque
  rupture and
• resulting thrombosis
• The possibility of embolism due to AF cannot be
  excluded
• Medical therapy Warfarin, low dose of aspirin
  and statin
• Follow-up CAG and OCT were performed 5 months
  later.

3
CAG and IVUS imaging
IVUS
Emaergent CAG
thrombus
mural thrombus
After aspiration
5 month later
thrombus
Seg 3100
thrombus
TIMI 3
Intact coronary
4
OCT imaging
Acute phase
5 months later
protruded plaque
thrombus
The pathogenesis of AMI was plaque rupture and
thrombus formation.
5
Conclusions

• We recently encountered a case of AMI which was
  followed up by OCT imaging both acute phase and
  5 months after onset.
• Dissolving mural thrombus, OCT imaging revealed
  the protruded (healed) plaque cleary at 5 months
  after onset.
• OCT can help clarify the pathogenesis of
• the culprit lesion at 5 months after onset.
• Warfarin can be ceased due to these findings.