Direct comparison of optical coherence tomography and high-definition 60-MHz intravascular ultrasound imaging of intra-procedural stent thrombosis in a patient with acute coronary syndrome.

An 80-year-old man with ST-segment elevation myocardial infraction underwent coronary stenting using an everolimus-eluting stent, which resulted in a good coronary flow with no residual stenosis. However, 10 min after final coronary angiography, the patient complained of chest discomfort and the ECG again showed ST elevation. Repeat coronary angiography revealed multiple contrast filling defects in the stent. High-definition 60-MHz intravascular ultrasound (IVUS) examination showed multiple low echoic structures inside the stent, though its visualization was not clear. We also conducted optical coherence tomography (OCT) for further investigation, which clearly delineated the outline of the thrombus. An additional balloon dilatation was performed at the site of the stented lesion, and the patient's chest discomfort was relieved, and the ECG was normalized. The clinical implication of this case is that very early phase of intra-stent thrombus is low-density and coarse, and its visualization is better in OCT than in high-definition 60 MHz IVUS.