1. Silent plaque rupture in the left main stem assessed by optical coherence tomography

    Silent plaque rupture in the left main stem assessed by optical coherence tomography

    A 59-year-old man underwent primary percutaneous coronary intervention (PCI) for thrombotic total occlusion of his distal right coronary artery. Bystander disease was limited to an ambiguous lesion in the distal left main stem (LMS) with an intraluminal filling defect suggestive of a ruptured plaque. A staged inpatient assessment of the LMS was undertaken utilizing invasive physiologic and intravascular imaging assessments as distal flow in the left coronary system was preserved and symptoms had settled with index intervention (Fig. 1A, B; Suppl. Video 1 and 2). Evaluation of the LMS lesion by instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR ...

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