case_images: PMC10762887_01
case_images: Electrocardiogram (ECG) at first medical contact. Pronounced ST-segment elevations are seen in the leads I, aVL, and V1-4.
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case_images: His physical examination was unremarkable (blood pressure 149/99 Hg, heart rate 69/min, saturation of arterial blood without added oxygen was 97%), but electrocardiogram revealed pronounced ST-segment elevations in anterior leads (Figure 1).
case_images: (A) Initial optical coherence tomography (OCT) pullback through the left anterior descending artery (LAD). The distal part of the artery is on the left side and the proximal part on the right. The culprit lesion is delimited with two red lines; it contains thin-cap fibroatheroma (TCFA), plaque fissure (PF) (first image in the lower panel), and superimposed white thrombus (third image in the upper panel). (B) Mid-culprit vessel site. Thin-cap fibroatheroma is seen from 10 to 12 o'clock and extends into the plaque fissure.
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case_images: The impression of diffuse CAD was confirmed since no 'healthy' arterial structure was seen within the examined LAD (Figure 3A); indeed, the intimal thickness throughout the vessel exceeded 600 microm. Importantly, the hallmark of an unstable lesion such as a thin-cap fibroatheroma, plaque rupture, and thrombus was clearly seen (Figure 3B).
case_images: Resting full-cycle ratio (RFR) pullback through the left anterior descending artery (LAD) 7 months after the primary event. The distal part of the artery is on the left side and the proximal on the right. A continuous pressure gradient representative for the diffuse atherosclerosis is observed throughout the entire LAD; there is no significant step-up at the stent site confirmed by simultaneous angiography.
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case_images: Moreover, the resting full-cycle ratio (RFR) was decreased to 0.82 (LLN, 0.90); the pullback from the distal LAD showed a continuous gradient without a step-up at the stent level (Figure 4).