Detection of Post-Stent Medial Dissection and White Thrombus Using Hybrid IVUS OCT Imaging may Help Guide Management.

We present a 66-year-old undergoing ostial-to-mid right coronary artery (RCA) percutaneous coronary intervention (PCI) lesion proximal to an existing stent in the mid-to-distal segment. The patient underwent PCI, with intravascular imaging using the Novasight Hybrid IVUS OCT (Conavi, Toronto, CA) which revealed a proximal edge dissection and distal dissection involving the media on OCT, less discernable on IVUS, which required an additional distal stent. Proximally, based on OCT minimal luminal area (MLA) measurements of the dissection, the size of the dissection flap and lack of involvement of the media, a stent was not placed. The patient did well with no periprocedural complications.