Rupture of a Vulnerable Plaque in a Hazy Angiographic Culprit Lesion During Acute Coronary Syndrome

In the presence of an equivocal culprit lesion in the context of an acute coronary syndrome, the optical coherence tomography (OCT) scan defines the severity and composition of the plaque, elucidating (as in this pathognomonic case) the mechanism related to plaque rupture. Furthermore, OCT analysis allowed stent implantation with adequate sizing and length, and subsequent final optimization of the result. In the presence of non-unequivocal lesions, in the context of acute coronary syndrome, the use of OCT imaging defined the etiology and mechanism of plaque instability, reducing cardiovascular events. In this clinical scenario, it is necessary to have a low threshold for the use of intracoronary imaging methods. In a challenging scenario, resorting to intracoronary imaging when possible can reduce the risk of procedural and postprocedural complication.