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[Collateral blood flow showing dissection-like filling defect on coronary arteriography: a case report]
Y Fukuoka1, M Sonoda, T Terashi
1Second Department of Internal Medicine, Faculty of Medicine, University of Kagoshima, Sakuragaoka 8-35-1, Kagoshima, Kagoshima 890-8520.
Insights
Severe coronary artery stenosis can mimic dissection due to collateral blood flow. This case highlights the importance of differentiating these findings to ensure accurate diagnosis and treatment for exertional chest pain.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- A 51-year-old male presented with exertional chest pain diagnosed as angina pectoris.
- Initial coronary angiography revealed severe stenosis with ulceration and spontaneous dissection in the proximal right coronary artery.
Observation:
- Repeat angiography after 3 months showed persistent stenosis with unclear dissection and developing collaterals from the left to the right coronary artery.
- These collaterals appeared to fill linear defects, mimicking distal dissection.
- Intravascular ultrasound confirmed severe atherosclerosis but no distal dissection.
Findings:
- The linear filling defects were attributed to collateral flow filling the distal right coronary artery, not true dissection.
- Successful percutaneous transluminal coronary angioplasty (PTCA) with stenting resolved the stenosis.
- Post-PTCA angiography showed resolution of collaterals and filling defects, confirming their nature.
Implications:
- Distinguishing collateral flow from coronary dissection is crucial for accurate diagnosis.
- This case underscores the importance of advanced imaging and serial angiography in complex coronary artery disease.
- Proper identification prevents misdiagnosis and ensures appropriate interventional strategies.
Abstract:
A 51-year-old man presented under a diagnosis of angina pectoris manifesting as exertional chest pain. First coronary angiography showed severe stenosis with ulceration and spontaneous dissection at the proximal right coronary artery and linear dissection-like filling defects extending to the distal right coronary artery. After about 3 months, repeat coronary angiography showed the previously observed stenosis with unclear dissection, and better developed collaterals from the left coronary artery to the right coronary artery showing the linear dissection-like filling defects. The bilateral coronary angiography did not clearly show filling defects. This phenomenon suggested that the collateral flows were related to filling of the defects. Intravascular ultrasonic imaging demonstrated severe atherosclerotic lesions at the proximal right coronary artery, but no dissection in the distal right coronary artery. Percutaneous transluminal coronary angioplasty for the stenosis was performed successfully with a stent. Coronary angiography after the angioplasty showed no collaterals, and the right ventricular branch appeared, suggesting that the linear dissection-like filling defects extending to the distal right coronary artery were due to the collateral flows. Filling defects extending distal to a severe stenosis must be distinguished carefully from coronary dissection.