Optical coherence tomographic image of an angiographically borderline lesion with a significant fractional flow reserve.

42-year-old diabetic woman presented with left ventricular dysfunction late after an Aanterior wall myocardial infarction. Fluoro-deoxy glucose-positron emission tomography showed viability in the left anterior descending artery (LAD) territory. Coronary angiogram (A, Online Video 1) showed a significant mid-LAD disease which was stented. Fractional flow reserve (B) done for the borderline lesions in the right coronary artery (RCA) was significant (0.53). Optical coherence tomography (C, D, E) done for the RCA lesion showed lotus root–like appearance (1) with multiple channels of varying diameters corresponding to the hazy lesion in the mid-RCA. The contrast flowing through these channels creates an illusion of a near normal luminogram even on different angiographic projections. Percutaneous coronary intervention to RCA was done successfully with drug-eluting stent (F, Online Video 2). This case best showcases the limitations of luminogram obtained by conventional angiogram and even a focal haziness without narrowing could be significant stenosis.