Intravascular imaging in Kounis syndrome: role of IVUS and OCT in achieving an etiopathogenic diagnosis

We report a case of a 60-year-old male patient presenting with anaphylactic response to anchovies associated with an acute coronary syndrome. His history was remarkable for coronary artery disease treated with a drug eluting stent to the right coronary artery six years before and stent fracture documented by coronary angiography four years prior to the event. Coronary angiography on admission revealed a very late stent thrombosis (VLST) in the right coronary artery. Intracoronary imaging techniques (IVUS and OCT) were used and were key to discard main causes of VLST. We described the characteristics of intracoronary images, along with the advantages and disadvantages of these techniques. The findings described in this case could explain a new physiopathological mechanism of stent thrombosis occurring in stent fractures.