IMAGES IN INTERVENTION Image of a Chronic Recanalized Thrombus by Intracoronary Imaging Intravascular Ultrasound and Optical Coherence Tomography Analysis Rodrigo Estévez-Loureiro, MD, Ramon Calvin ˜o-Santos, MD, Jorge Salgado-Ferna ´ndez, MD, Angela Lo ´pez-Sainz, MD, Marcos Garcı ´a-Guimaraes, MD, Pablo Pin ˜o ´n-Esteban, MD, Guillermo Aldama-Lo ´pez, MD, Nicola ´s Vazquez-Gonzalez, MD, Alfonso Castro-Beiras, PHD A Corun ˜ a, Spain A 65-year-old male was admitted to our institution due to atypical chest pain. His previous medical history revealed the presence of an anterior wall myocardial infarction that extended clinically silent 30 years ago. Angiographic images revealed the presence of a linear filling defect in the proximal left anterior descending artery (LAD) (Fig. 1). For fur- ther characterization of the lesion we decided to perform an intravascular ultrasound (IVUS), showing a coronary lumen divided into several cavities and partitioned by ultrasound tissue similar to the intima (Fig. 2). We also performed an optical coherence tomography study, where we can observe more clearly the multi-lumen appearance of the lesion but with more cavities than observed with IVUS and more clearly defined intima-like wall (Fig. 3). The most plausible mechanism for that image is the presence of an old thrombus (history of previous myocardial infarction) with subsequent recanalization and for- mation of multiple lumens. Intracoronary diagnostic imaging techniques have given interventional cardiologists a better under- standing of coronary disease and how to optimize percutaneous coronary interventions. Optical coher- ence tomography has become a key coronary imaging diagnostic tool and, due to its greater spatial resolu- tion (15 m), is able to better characterize the processes of atherosclerotic plaques, providing addi- tional detailed structural information over IVUS im- aging (1,2). Thus, optical coherence tomography From the Interventional Cardiology Unit, Hospital Universitario A Corun ˜ a, A Corun ˜ a, Spain. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received July 12, 2012; revised manuscript received August 2, 2012, accepted August 16, 2012. Figure 1. Angiographic Image Angiographic image showing a linear filling defect at the level of proximal left anterior descending artery (arrows). JACC: CARDIOVASCULAR INTERVENTIONS VOL. 5, NO. 11, 2012 © 2012 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00 PUBLISHED BY ELSEVIER INC. http://dx.doi.org/10.1016/j.jcin.2012.08.008