Large atherosclerotic plaque related severe right coronary artery dissection during coronary angiography

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Catheter-induced coronary artery dissection and occlusion are rare but serious complications of diagnostic cardiac angiography.
• Unstable angina is a common presentation requiring urgent investigation.

Observation:

• A 50-year-old male presented with unstable angina and was found to have significant left anterior descending artery stenosis.
• During right coronary angiography, catheter manipulation near the aortic valve led to severe chest discomfort and acute inferior wall myocardial infarction.
• Spiral dissection (NHLBI Grade IV) was observed in the right coronary artery, originating from the ostium to the posterior descending and posterolateral artery bifurcation.

Findings:

• Iatrogenic coronary artery dissection, specifically in the right coronary artery, can precipitate acute myocardial infarction.
• The dissection was severe (NHLBI Grade IV) and occurred despite the absence of pre-existing significant obstruction in the right coronary artery.

Implications:

• This case highlights the critical importance of meticulous catheter technique during cardiac angiography to prevent iatrogenic injuries.
• Prompt surgical intervention, such as off-pump coronary artery bypass surgery, can be life-saving in managing complex iatrogenic coronary dissections.
• Awareness of this rare complication is crucial for cardiologists and interventionalists to ensure timely diagnosis and management.