Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 60 years-old female, past smoker with hypertension, hyperlipidemia, peripheral arterial disease, presented angina for two month. She admitted to our hospital.
BH: 152 cm, BW: 57 kg, BT: 36.5 °C,HR: 85 bpm, regular, BP: 154/73 mmHg, SpO2: 96% (rest,room air)
[Chest] symmetric, no deformity,breath sounds: no rale
[Cardiovascular] heart sounds: no pathological murmur
[Extremities] no edema
Relevant test results prior to catheterization
Electorocardiogram revealed Q wave in III lead, negative T in V1-5 leads. Transthroacic echocardiography revealed inferior-wall mild hypokinesis. Left ventricular ejection fraction 62%. Adenosine triphosphate stress myocardial perfusion imaging revealed inferior wall redistribution.
Relevant catheterization findings
Coronary Angiogram (CAG) Right Coronary Artery(RCA) #3 99% (functional occlusion). Left Anterior Descending Artery (LAD) and Left Circumflex Artery (LCX) patent.
We chose right transradial approach, and the guiding catheter was 6F. AL1 Profit, Goodman, the guide wire was Asahi Sion blue, micro catheter was Corsair. Sion blue could not pass through the lesion,therefore, we tried to pass through distal RCA with XT-R and Corsair. Then, the wire advanced into false lumen, we checked intravascular ultrasound (IVUS) image. The image showed that coronary dissection originated the guide wire. We marked the entry point of the dissection by IVUS. We tried to delivery Gaia 1st. Because we were taking IVUS image, we could recognized the wire passed to RCA# 4PD through the true lumen. After balloon (IKAZUCHI ZERO 1.5 × 15) was inflated in #3, IVUS could pass the lesion. IVUS image revealed large hematoma progress to RCA # 4PD and # 4PL. By using Crusade catheter, we could delivery Sion to # 4PL from # 4PD true lumen. We released the intramural hematoma by 3.0 × 10 mm cutting balloon (Flextome), after that, we deployed 3.0 × 18 mm everolimus-eluting stents(XienceAlpine) in only #3 for the purpose of sealing the entry point. Because we archived RCA TIMI III flow successfully, we did not deployed stent # 4PD and #4PL. Although there remained coronary dissection, coronary flow was good, and we thought it would be healing. She is still asymptomatic.
Wire-induced coronary dissection is not rare complication. Using IVUS, we could passed to the true lumen. Additionally,the controlled dissection by adequate-size cutting balloon was an effective method to solve this problem. Our procedure is one of useful option to bail out coronary dissection.