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Areas coveredIn this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients.Expert opinionAlthough the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases
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