First report of lotus root-like appearance at the site of coronary spasm in a patient with acute coronary syndrome

摘要

A 65-year-old man without coronary risk factors was hospitalizeddue to frequent chest pain at rest in the early morning. Although electrocardiographyshowed no significant findings of myocardial ischaemia,his serum troponin I level was elevated at 0.3303 ng/mL (thenormal level: 0.032 ng/mL). He was diagnosed with non-STelevationacute coronary syndrome (NSTE-ACS) and underwentcardiac catheterization. Coronary angiography revealed severe stenosisin the middle left anterior descending (LAD) coronary artery(Panels A1 and A2). Optical coherence tomography (OCT) imagingfor detailed evaluation of the bifurcation lesion showed mural thrombus(Panel B1, asterisk) and multiple channels called a ‘lotus root-likeappearance’ without atherosclerosis (Panels B2–B4). The lesion wasdilated successfully using a cutting balloon (as the first choice) and adrug-coated balloon (Panel A3). Since vasospastic angina was suspecteddue to his medical history and absence of atheroscleroticchanges around the lesion on OCT imaging, we performed a spasmprovocation test 1 month after coronary intervention. After intracoronaryinjection of ergonovine which causes vascular smoothmuscle contraction mainly via activation of serotonergic receptors,he complained of chest pain, and electrocardiography showed STsegmentelevation (Panel C). Coronary angiography demonstratedtotal occlusion of LAD (Panel D, arrowhead). Thus, he was diagnosedwith vasospastic angina.