| Summary: | The calcified nodule has been established as the least common underlying substrate in the acute coronary syndrome; however calcium can be widely present in other acute-common scenarios. In this setting, the optical coherence tomography (OCT) study has identified 3 different types of calcification according to morphology. Former studies have already documented calcified nodules in patients with peripheral artery disease; however the different patterns that exist beyond coronary arteries remain unknown. An 80-year-old patient was referred for coronary angiography following systolic dysfunction. The coronary angiography performed through right radial approach showed a severely calcified vessel (mid portion of the left anterior descending artery) and mitral and aortic calcification. The OCT pullback performed with 6 mL of contrast at 3 mm/seg through the radial artery removed 4 cm of the radial sheath and showed multiple calcified plaques (mid portion of the artery) defined by the presence of superficial, well-established, low-backscattering and heterogeneous regions (video 1 of the supplementary data). The simultaneous angiography co-registration confirmed the presence of ulnar artery occlusion.
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