Vitale G, Vitale S, Pietro P, Visconti CL (2019) A Minus That Makes the Difference. J Fam Med Dis Prev 5:108.


© 2019 Vitale G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Case Report | OPEN ACCESS DOI: 10.23937/2469-5793/1510108

A Minus That Makes the Difference

Vitale G1*, Vitale S2, Pierini P3 and Visconti CL4

1Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy

2Medical Biotechnology and Molecular Medicine, University of Palermo, Italy

3Department of Pharmacy, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy

4Cardiology and Intensive Coronary Unit Department, San Giovanni Di Dio Hospital, Agrigento, Italy



Acute Coronary Syndromes include a wide variety of clinical scenarios. Coronary Angiography (CA) is a low-resolution imaging technique and its inability to provide a satisfactory tissue characterization of culprit lesions could be a concern in some cases. Optical Coherence Tomography (OCT) is an emergent intravascular high-resolution imaging modality which could be complementary to CA in challenging cases. We report a case of a young man in whom OCT had been determinant to understand the pathology of culprit lesion and to formulate a tailored therapy.

Case presentation

We report a case of a 28-years-old man, presenting to the emergency department and complaining of acute chest pain lasting about 30 minutes. Cardiovascular risk factors were cigarette smoking and familial history of Coronary Artery Disease. At admission both EKG and echocardiogram were unremarkable; a mild positivization of high sensitive troponine T was detected. The next day CA was performed showing a "minus" image in the proximal Left Anterior Descendent Artery (LAD), highly suspicious for a pedunculated, non-stenosing, adherent wall thrombus which prompted adequate antithrombotic and anticoagulant therapy. At control angiography we performed an OCT study which showed a thin-capped eccentric vulnerable plaque. We therefore decided to implant a bioresorbable scaffold on the proximal LAD. Subsequent thrombophilia screening showed severe hyperhomocysteinemia and homozygous C677T Methylenetetrahydrofolate Reductase mutation. The patient was discharged home 2 days later on aspirin, ticagrelor, folic acid and vitamins B6 and B12. At 6-month follow-up, a new OCT image acquisition showed satisfactory apposition of the bioresorbable scaffold.


OCT is a promising high-resolution intravascular imaging modality able to provide a comprehensive tissue characterization of unstable coronary plaques. OCT should be used as a complementary technique in challenging clinical scenarios.