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Maričić B, Perišić Z, Kostić T, Božinović N, Apostolović S, Šalinger S, Maričić T, Vasilev V, Juričić S, Dakić S, Perišić J, Milošević J. Diagnosis and treatment of angiographically unclear coronary lesions. J Int Med Res 2024; 52:3000605231213753. [PMID: 38179714 PMCID: PMC10771071 DOI: 10.1177/03000605231213753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/26/2023] [Indexed: 01/06/2024] Open
Abstract
Although selective coronary angiography is the gold standard diagnostic technique for coronary lesions, this method does not provide all information regarding pathophysiologic mechanisms. We herein describe a patient in their early 60s with a 3-month history of pronounced angina. Coronary angiography revealed a central line of illumination in the proximomedial segment of the right coronary artery, suggesting a chronic coronary dissection/recanalized thrombus, along with positive remodeling and TIMI grade 2 flow. Optical coherence tomography showed a recanalized thrombus and multiple lumens separated by thin septa. Because of the significantly reduced flow and signs of ischemia in the right coronary artery irrigation territory, we decided to perform percutaneous coronary intervention. Post-treatment optical coherence tomography indicated optimal apposition and expansion of the stents with positive remodeling of the blood vessel. We believe that decisions regarding treatment modalities should be guided by the presence or absence of ischemia. Lesions that are causing myocardial ischemia should be revascularized; otherwise, medical treatment can be utilized.
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Affiliation(s)
- Bojan Maričić
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
| | - Zoran Perišić
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
- Faculty of Medicine, University of Niš, Niš 18000, Serbia
| | - Tomislav Kostić
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
- Faculty of Medicine, University of Niš, Niš 18000, Serbia
| | - Nenad Božinović
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
- Faculty of Medicine, University of Niš, Niš 18000, Serbia
| | - Svetlana Apostolović
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
- Faculty of Medicine, University of Niš, Niš 18000, Serbia
| | - Sonja Šalinger
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
- Faculty of Medicine, University of Niš, Niš 18000, Serbia
| | - Tijana Maričić
- Clinic for Anestesiology, Reanimatology and Intensive Care, University Clinical Center Niš, Niš 18000, Serbia
| | | | - Stefan Juričić
- Clinic of Cardiology, Clinical Centre of Serbia, Belgrade 11000, Serbia
| | - Sonja Dakić
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
- Faculty of Medicine, University of Niš, Niš 18000, Serbia
| | - Jelena Perišić
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
| | - Jelena Milošević
- Clinic of Cardiology, University Clinical Center Niš, Niš 18000, Serbia
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