Extrinsic compression of the left main coronary artery (LMCA) secondary to pulmonary artery dilatation is a rare syndrome. Most cases of pulmonary artery hypertension but no atherosclerotic risk factors rarely undergo coronary angiography, and hence, diagnoses are seldom made and proper management is often delayed in these patients. We describe a patient that presented with pulmonary hypertension, clinical angina, and extrinsic compression of the LMCA by the pulmonary artery, who was treated successfully by percutaneous coronary intervention. Follow-up coronary angiography showed patent stent in the LMCA in the proximity of the dilated main pulmonary artery. This case reminds us that coronary angiography and percutaneous coronary intervention should be considered in pulmonary hypertension patients presenting with angina or left ventricular dysfunction.
Angina Pectoris/etiology ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Stenosis/radiography/therapy ; Coronary Vessels/radiography/*ultrasonography ; Dilatation, Pathologic ; Female ; Humans ; Hypertension, Pulmonary/etiology/radiography ; Middle Aged ; Pulmonary Artery/radiography/*ultrasonography ; Stents ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left

Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) that can be used to examine the coronary arteries and has 10-fold higher resolution than IVUS. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify thin-cap fibroatheroma. Because of the strong attenuation of light by blood, OCT systems required the removal of blood during OCT examinations. A recently developed frequency-domain OCT system has a faster frame rate and pullback speed, making the OCT procedure more user-friendly and not requiring proximal balloon occlusion. During percutaneous coronary intervention (PCI), OCT can provide detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition [ISA]). At follow-up examinations after stent implantation, stent strut coverage and ISA can be assessed. Several OCT studies have demonstrated delayed neointimal coverage following drug-eluting stent (DES) implantation vs. bare metal stent (BMS) placement. While newer DESs promote more favorable vascular healing, the clinical implications remain unknown. Recent OCT studies have provided insights into restenotic tissue characteristics; DES restenotic morphologies differ from those with BMSs. OCT is a novel, promising imaging modality; with more in-depth assessments of its use, it may impact clinical outcomes in patients with symptomatic coronary artery disease.
*Angioplasty, Balloon, Coronary/adverse effects/instrumentation ; Coronary Angiography ; Coronary Artery Disease/*pathology/radiography/*therapy/ultrasonography ; Coronary Restenosis/etiology/pathology ; Coronary Vessels/*pathology/ultrasonography ; Humans ; Predictive Value of Tests ; Severity of Illness Index ; Stents ; *Tomography, Optical Coherence ; Treatment Outcome ; Ultrasonography, Interventional

The aim of this study was to evaluate the relationship between coronary artery calcium score (CACS) assessed by multidetector computed tomography (MDCT) and plaque components assessed by virtual histology-intravascular ultrasound (VH-IVUS) in 172 coronary artery disease (CAD) patients with 250 coronary lesions. CACS was assessed according to Agatston scoring method by MDCT and patients were divided into four groups: Group I (CACS = 0 [n = 52]); Group II (CACS = 1-100 [n = 99]); Group III (CACS = 101-400 [n = 84]); and Group IV (CACS > 400 [n = 15]). Total atheroma volume was greatest in Group IV (152 +/- 132 microL vs 171 +/- 114 microL vs 195 +/- 149 microL vs 321+/-182 microL, P < 0.001). The absolute dense calcium (DC) and necrotic core (NC) volumes were greatest, and relative DC volume was greatest in Group IV (5.5 +/- 6.6 microL vs 11.0 +/- 10.3 microL vs 15.6 +/- 13.6 microL vs 36.6 +/- 18.2 microL, P < 0.001, and 14.8 +/- 18.2 microL vs 19.5 +/- 18.9 microL vs 22.5 +/- 19.1 microL vs 41.7 +/- 27.9 microL, P < 0.001, and 6.4 +/- 5.3% vs 11.0 +/- 6.2% vs 14.0 +/- 6.5% vs 20.0 +/- 7.8%, P < 0.001, respectively). The absolute plaque and DC and NC volumes and the relative DC volume correlated positively with calcium score. CAD patients with high calcium score have more vulnerable plaque components (greater DC and NC-containing plaques) than those with low calcium score.
Adult ; Aged ; Calcinosis/*diagnosis/radiography/ultrasonography ; Calcium/*analysis ; Coronary Angiography ; Coronary Artery Disease/*diagnosis/radiography/ultrasonography ; Coronary Vessels/pathology ; Female ; Humans ; Male ; Middle Aged ; *Multidetector Computed Tomography ; Necrosis ; Plaque, Atherosclerotic/*pathology ; *Ultrasonography, Interventional

Image fusion is fast catching attention as Wagner pointed out in his 2006 version of the recent progress and development presented at the annual meeting of Society of Nuclear Medicine. Prototypical fusion of bone scan and radiograph was already attempted at in 1961 when Fleming et al. published an article on strontium-85 bone scan. They simply superimposed dot scan on radiograph enabling simultaneous assessment of altered bone metabolism and local bone anatomy. Indeed the parallel reading of images of bone scan and radiography, CT, MRI or ultrasonography has been practiced in nuclear medicine long since. It is fortunate that recent development of computer science and technology along with the availability of refined CT and SPECT machines has permitted us to open a new avenue to digitally produce precise fusion image so that they can readily be read, exchanged and disseminated using internet. Ten years ago fusion was performed using Bresstrahlung SPECT/CT and it is now achievable by PET/CT and SPECT/CT software and SPECT/CT hardware. The merit of image fusion is its feasibility of reliable assessment of morphological and metabolic change. It is now applicable not only to stationary organs such as brain and skeleton but also to moving organs such as the heart, lung and stomach. Recently, we could create useful fusion image of cardiac SPECT and 64-channel CT angiograph. The former provided myocardial metabolic profile and the latter vascular narrowing in two patients with coronary artery stenosis and myocardial ischemia. Arterial stenosis was severe in Case 1 and mild in Case 2.
Angiography* ; Brain ; Constriction, Pathologic ; Coronary Stenosis* ; Coronary Vessels* ; Heart ; Humans ; Internet ; Lung ; Magnetic Resonance Imaging ; Metabolism ; Metabolome ; Microcomputers* ; Myocardial Ischemia ; Nuclear Medicine ; Positron-Emission Tomography and Computed Tomography ; Radiography ; Skeleton ; Stomach ; Tomography, Emission-Computed, Single-Photon* ; Ultrasonography