Coronary Artery Fenestration Guided by Optical Coherence Tomograhy Before Stenting

A 46-year-old woman, with a medical history of 7 hormonal stimulation attempts for in vitro fertilization in the past 2 years and moderate smoking, presented at the emergency department during the first hour of chest pain. ECG showed ST-segment–elevation myocardial infarction in anterior derivations. Emergency coronary angiography did not show atheroma but suggested a long intramural hematoma on left anterior descending coronary artery from the first septal branch, with Thrombolysis In Myocardial Infarction myocardial perfusion grade 1 flow (Figure [A]). Endocoronary optical coherence tomographic imaging confirmed intramural hematoma compressing true lumen without intimal rupture or thrombus (Figure [A′]). Delayed …