Side-by-side false and true lumen stenting for recanalization of the chronically occluded right coronary artery

Area of Science:

• Interventional Cardiology
• Vascular Biology

Background:

• Subintimal or false lumen stent deployment is a rare but significant complication of percutaneous coronary interventions (PCI).
• While minor dissections often heal spontaneously, severe flow-limiting dissections can lead to abrupt vessel closure, thrombosis, myocardial ischemia, and necrosis.
• Accurate guide-wire placement within the true lumen is critical, especially in total occlusive lesions, to prevent impaired distal coronary flow.

Observation:

• The case involves a patient who underwent PCI with an initial accidental stent deployment into the false lumen of the proximal right coronary artery.
• This complication occurred despite the complexity of the lesion, potentially involving total occlusion.

Findings:

• Despite the initial false lumen stenting, successful coronary recanalization was achieved.
• The procedure was ultimately completed with subsequent true lumen stenting, restoring normal coronary flow.

Implications:

• This case underscores the importance of meticulous guide-wire manipulation and lumen confirmation prior to stent deployment in complex PCI.
• It demonstrates that even with initial maldeployment into the false lumen, successful recanalization and favorable outcomes are possible with appropriate corrective measures.
• The findings reinforce the critical role of true lumen stenting for preventing adverse cardiovascular events following PCI.