An Iatrogenic Dissection of Right Coronary Artery
Dr. Yong DONG
Zhengzhou Cardiovascular Hospital, The 7th People’s Hospital of Zhengzhou, China
A patient was admitted for coronary intervention. Coronary angiography showed critical stenosis in mid to distal RCA (Movie 1). Right coronary artery was engaged with XBRCA 6Fr guiding catheter and Sion wire was passed to PDA (Figure 1). After POBA with 2.0mm balloon, coronary check showed severe dissection of proximal RCA extending to ascending aorta. Attempting disengaging guiding catheter finally ended up with withdrawal of the whole system (guiding catheter and wire) (Figure 2). Right coronary artery was engaged with JR3.5 6Fr guiding catheter and Sion wire could not pass beyond mid RCA. IVUS check showed wire in false space. Another Run-through NS wire was also in false space with true space at 8-9 o’clock region (Figure 3). Under IVUS guidance, the Run-through wire finally entered into true lumen and passed down to PDA (Figure 4). After POBA via Run-through wire, IVUS showed severe intramural hematoma extending from ostial to mid RCA (Figure 5, Movie 2). RCA was then stented with DES 2.5/36mm, 3.0/18mm and 3.5/24mm with proximal stent extending out to aorta (Figure 6). Final angiography showed residual small contrast extending to aorta root inferior to ostial RCA (Movie 3). Final IVUS revealed small dissection at aorta root at 5-7 o’clock region (Figure 7).
