Abstract
BACKGROUND: Histologically, intraplaque hemorrhage (IPH) is a recognized cause of acute coronary syndrome. However, the in vivo lesion characteristics of IPH and mechanisms leading to acute coronary syndrome remain unclear. CASE SUMMARY: A 77-year-old woman presented with chest pain at rest or on light exertion and new electrocardiographic changes. Cardiac computed tomography angiography demonstrated significant stenosis with the napkin-ring sign in the left anterior descending artery. Preintervention optical coherence tomography (OCT) revealed heterogeneous signal-poor regions with delineated borders and a white thrombus. Coronary angioscopy showed reddish plaque with an exposed red thrombus and adjacent white thrombus. OCT after excimer laser coronary angioplasty demonstrated localized ablation of the low-intensity area, suggesting solidified hemorrhagic material. DISCUSSION: Combined use of coronary angioscopy and OCT enables comprehensive macroscopic diagnosis and pathophysiological assessment of IPH lesions. TAKE-HOME MESSAGE: Multiple imaging with coronary angioscopy and OCT provides valuable insights into the mechanism of progression of IPH lesions.