Percutaneous Optical Coherence Tomography Reveals Coronary Artery Rupture and Pseudo-aneurysm

BACKGROUND: A patient with coronary rupture and subsequent pseudoaneurysm was successfully recorded by angiography and optical coherence tomography (OCT). CASE SUMMARY: A 61-year-old man presented with angina. Coronary angiography revealed diffuse stenosis of the left anterior descending artery. After stent implantation, postdilatation angiography showed contrast extravasation, and OCT confirmed vessel rupture. However, the patient remained hemodynamically stable, and serial bedside echocardiography detected no pericardial effusion. At more than 1-year follow-up, angiography revealed aneurysmal dilatation and OCT demonstrated a pseudoaneurysm at the site of the prior perforation. DISCUSSION: This is to our knowledge the first in vivo report of coronary rupture and subsequent pseudoaneurysm formation documented by OCT, highlighting the value of high-resolution imaging for image-guided coronary intervention. TAKE-HOME MESSAGES: Poststent balloon dilation significantly increases the risk of coronary artery rupture and intramural hematoma formation. OCT provides high-resolution intravascular imaging that enables precise assessment of vessel pathology and facilitates individualized treatment strategies for optimal patient outcomes.