Discordance Between Coronary Angiography and Intracoronary Ultrasound
A 57-year-old woman presented with typical angina. Thallium stress testing showed anteroapical reversible ischemia. Coronary angiography demonstrated only a mild stenosis (open black arrow) of the mid-left anterior descending coronary artery (LAD). She was treated medically and did not improve. Intravascular ultrasound examination was used to further evaluate this ambiguous coronary stenosis.
Angiogram of left coronary system and six ultrasound images acquired at various locations within LAD, shown by white arrows. A 7F diagnostic catheter (solid short white arrow) provides a reference diameter of 2.2 mm. A, Image from mid-left main coronary artery. Vessel lumen is compromised by a crescentic fibrous plaque extending from 7 o’clock to 2 o’clock position. B, Bifurcation of left main artery into LAD and left circumflex (LCX). C, Proximal reference vessel. Lumen diameter is ≈3×3 mm. Black hash mark at 3 o’clock position shows a 1-mm calibration. D, Entry into this indeterminate lesion has only a small rim of echolucent lumen around ultrasound catheter. A near circumferential plaque fills rest of lumen. E, Tightest point seen by intravascular ultrasound demonstrates white echodense plaque surrounding ultrasound catheter, almost obliterating vessel lumen. F, Distal reference artery beyond stenosis shows a widely patent vessel with minimal atherosclerosis.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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