Blasco-Turrión Sara, Gómez-López Andrea, Morales-Ponce Francisco J, Casquero-Domínguez Sara, Del Pozo-Contreras Rocío
Interventional Cardiology Unit, Puerto Real University Hospital, Calle Romería, 7, Puerto Real, Cádiz 11510, Spain.
Eur Heart J Case Rep. 2023 Sep 8;7(9):ytad444. doi: 10.1093/ehjcr/ytad444. eCollection 2023 Sep.
The evaluation of a three-dimensional structure with a two-dimensional imaging technique makes intracoronary diagnostic techniques essential, especially in the setting of acute myocardial infarction (AMI) when no apparent coronary lesions are detected. Expert consensus recommend their use in certain scenarios such as angiographically ambiguous disease and identification of the culprit lesion. Although both intravascular ultrasound and optical coherence tomography (OCT) allow the characterization of the atherosclerotic plaque and assess the immediate and long-term results of stent implantation, they have their own benefits and limitations that make them ideal for different types of coronary lesions.
We present the case of a lateral ST-elevation myocardial infarction with no evident coronary lesions in angiography, in which OCT not only allowed us to confirm a diagonal branch occlusion, but it also became crucial to locate the occlusion point and to guide the procedure, allowing complete revascularization of the culprit lesion that otherwise could have been missed.
To know the actual limitations of conventional coronary angiography to adequately assess coronary disease, intracoronary diagnostic techniques are key to evaluate the underlying mechanisms of the event, especially in the setting of AMI when no clear culprit lesion has been identified. They can be of great value to locate and revascularize acute occlusions that could go unnoticed on the angiogram, guiding the revascularization and stent implantation and, therefore, preventing myocardial injury that could become irreversible when coronary disease is not treated promptly.
用二维成像技术评估三维结构使得冠状动脉内诊断技术至关重要，尤其是在急性心肌梗死（AMI）且未检测到明显冠状动脉病变的情况下。专家共识建议在某些情况下使用它们，例如血管造影显示不明确的疾病以及确定罪犯病变。虽然血管内超声和光学相干断层扫描（OCT）都可以对动脉粥样硬化斑块进行特征描述，并评估支架植入的即刻和长期效果，但它们各有优缺点，适用于不同类型的冠状动脉病变。
我们报告一例侧壁ST段抬高型心肌梗死患者，血管造影未发现明显冠状动脉病变，在该病例中，OCT不仅使我们能够确认对角支闭塞，而且对于确定闭塞点和指导手术也至关重要，使罪犯病变得以完全血运重建，否则可能会被遗漏。
了解传统冠状动脉造影在充分评估冠状动脉疾病方面的实际局限性，冠状动脉内诊断技术是评估事件潜在机制的关键，尤其是在AMI且未明确罪犯病变的情况下。它们对于定位和使血管造影可能未发现的急性闭塞恢复血运非常有价值，指导血运重建和支架植入，从而预防冠状动脉疾病未及时治疗时可能变得不可逆转的心肌损伤。
