Frequency-domain optical coherence tomography evaluation of a patient with Kawasaki disease and severely calcified plaque  Yusuke Fujino, Guilherme F. Attizzani, Satoko Tahara, Kensuke Takagi, Hiram G. Bezerra, Sunao Nakamura, Marco A. Costa  International Journal of Cardiology  Volume 171, Issue 2, Pages 281-283 (February 2014) DOI: 10.1016/j.ijcard.2013.11.084 Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Angiography of RCA and LAD pre-PCI and angiography, IVUS and OCT images of LAD after rotational atherectomy (RA). Angiogram shows an aneurysmal formation in RCA ostium (white arrow) (I) and a severe, calcified stenosis also with an aneurysmal formation in LAD (white arrow) (II). Angiography (III) shows mid LAD lesion after RA. Highly calcified lesion is shown by IVUS and OCT (IV/V-A and B; white arrow heads show calcified plaque and white arrows show modified plaque by RA). Lumen (green contour) and calcified plaque dimensions (purple contour) by OCT are shown in (V-A′, and V-B′). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) International Journal of Cardiology 2014 171, 281-283DOI: (10.1016/j.ijcard.2013.11.084) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 Angiography and OCT assessments following EES implantation and after post-dilatations. Angiography (I) shows lesion after EES implantation and initial post-dilation with 3.5×12mm balloon in LAD. OCT showed good stent expansion in proximal and distal part of the lesion (II-A/C); however, marked stent under expansion was shown in the most calcified region (II-B). In (II-B′) lumen geometry (area: 4.36mm2, mean diameter: 2.29mm), calcified plaque thickness (blue, purple, and yellow lines: 0.59mm, 0.99mm, and 1.70mm, respectively), and outer tracing of calcified plaque showing vessel dimensions (area 17.51mm2, mean diameter: 4.72mm, minimum diameter: 4.54mm, and maximum-diameter: 4.99mm) are depicted. Three-dimensional (3-D) reconstruction images of the stent clearly show the underexpansion (II-D, arrows, and E, flythrough), while longitudinal image (F, dashed line B), as well as 3-D luminal reconstruction also depict the underexpansion. Angiography (III) shows EES after second intra-stent post-dilation with 4.0×12mm non-compliant balloon guided by OCT information. Improved, though not uniform, stent expansion in severe calcified lesion is demonstrated (IV-B and B′, white arrow heads showed tear sites after dilatation). Three-dimensional reconstruction images clearly depict favorable overall stent expansion (IV-D, E and G). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) International Journal of Cardiology 2014 171, 281-283DOI: (10.1016/j.ijcard.2013.11.084) Copyright © 2013 Elsevier Ireland Ltd Terms and Conditions