Optical coherence tomography plaque characterization in a patient with ST segment elevation myocardial infarction after cocaine intake

- Optical coherence tomography (OCT) was used to characterize a coronary artery plaque.
- OCT detected coronary plaque erosion in a young male with MI due to cocaine abuse.
- OCT was used to document thrombus resolution.

A 28-year old man presented to the Emergency Department with malaise after cocaine intake. After arrival he developed retrosternal chest pain and the electrocardiogram showed ST segment elevations in V1-V2 and ST segment depressions in V5-V6. An acute coronary angiogram revealed a focal non-occlusive lesion with thrombus in the left anterior descending artery. Supplementary optical coherence tomography (OCT) detected plaque erosion with adherent thrombus to be the responsible underlying pathophysiological mechanism. The patient received an effective antithrombotic regimen. Repeat angiogram with additional OCT one month later documented thrombus resolution and complete restoration of the previously eroded coronary vascular surface area.