Fig. 1

a Final left coronary angiography (CAG, right anterior oblique caudal view) at prior hospital did not show any significant obstruction from proximal left anterior descending coronary artery (LAD) to left main trunk (left panel). A stented segment is shown in white double-headed dashed arrow. Intravascular ultrasound (IVUS) image at just proximal LAD clearly demonstrated deformed stent struts protruding toward the lumen (white arrowhead), however, adhesion of thrombus to the struts was ambiguous on the IVUS image (right panel). The site of stent deformation was indicated by white arrow head on CAG (left panel). b Optical coherence tomography (OCT) imaging around the deformed struts performed at our hospital clearly showed thrombus adhesion to the deformed struts with radial signal attenuation behind the adherent structure to the struts (white arrowhead, left panel). 3D reconstruction image from proximal LAD to left main trunk (LMT) visualized fractured struts extending to the LMT direction shown in light blue (right panel). c Additional percutaneous coronary intervention underwent at our hospital. A 3.5x23mm EES was implanted from LMT to LAD (left panel). Kissing balloon technique using 3.5x15mm and 3.0x15mm non-compliant balloons were performed (middle panel). Final CAG after additional stenting followed by KBT (right panel). A stented segment is shown in white double-headed dashed arrow