Optical coherence tomography-guided approach in diagnosing and managing spontaneously recanalized coronary thrombus

Recanalized coronary thrombus is a rare and under-recognized condition in interventional practice, however its incidence is steadily increasing with the use of endo-coronary imaging. It has been initially described by pathological studies in approximately one-third of chronic coronary occlusions. It is described as a chronic occlusion that constitutes several endothelium-covered channels separated by septa that converge into a single lumen. In angiographic studies, it is often misidentified as fresh thrombus, spontaneous coronary artery dissection or severe calcification. Hence the interest of intracoronary imaging, particularly optical coherence tomography, to conclusively establish its diagnosis and identify the related mechanism in order to guide the optimal therapeutic strategy. In this report, we describe our experience with a case of recanalized thrombus diagnosed using intracoronary optical coherence tomography imaging with successful percutaneous coronary intervention.