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Successful Tip Detection-Antegrade Dissection and Re-Entry for Chronic Iatrogenic Coronary Artery Dissection Using a
Bayushi Eka Putra1,2, Umihiko Kaneko1, Yutaka Tadano1
1Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan.
Insights
This study demonstrates successful percutaneous coronary intervention (PCI) for a complex posterior lateral artery dissection. Advanced intravascular ultrasound (IVUS) guided true lumen re-entry and stent deployment, resolving angina.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Recurrent exertional angina can result from complex coronary artery disease.
- Chronic dissections pose significant challenges for percutaneous coronary intervention (PCI).
- Successful revascularization is crucial for symptom relief and improved outcomes.
Abstract:
A 57-year-old man presented with recurrent exertional angina 1 month after an unsuccessful PCI attempt elsewhere. Angiography revealed severe stenosis and a chronic dissection of the posterior lateral artery (PLA). PCI was performed via a 6 Fr right transradial guiding catheter. Initial intravascular ultrasound (IVUS) using OptiCross HD (Boston Scientific; 3.1 Fr outer diameter [OD], 20 mm transducer-to-tip distance [TTD]) confirmed guidewire placement in the subintimal space within the extensive chronic dissection. TD-ADR was successfully performed using the OptiCross HD IVUS and a low-profile Carnelian MARVEL microcatheter (1.9 Fr OD), both accommodated within the 6 Fr guide. True lumen re-entry was achieved, followed by balloon dilatation, side branch management, and successful drug-eluting stent deployment in the main vessel, confirmed by final angiography and IVUS.
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