A 45-year-old male with non-ST segment elevation coronary syndrome. Coronariography showed mild stenosis with smooth margins in the proximal anterior descending artery (Fig. 1A, arrow). Vasospasm testing proved clinically, electrically and angiographically positive (Fig. 1B: absence of flow–arrows). Optical coherence tomography (OCT) in turn revealed an underlying atheroma plaque of fibrolipidic characteristics, with no evidence of rupture (Fig. 1C). A curious thin laminar thrombus of platelet characteristics was identified, lining the endothelium (arrows). Vasospasm proved recurrent, leading to invasive re-evaluation; the OCT study one month later showed the laminar thrombus in the spastic zone to have become incorporated into the wall, forming a continuum with the arterial intimal layer (Fig. 1D; * guide artifact).

Figure 1

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