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The crumpled coronary: an enigma of arteriographic pseudopathology and its potential for misinterpretation
J T Hays1, B Stein, A E Raizner
1Department of Medicine, Methodist Hospital, Houston, Texas 77030.
Insights
Interventional cardiologists should recognize pseudo-narrowing, a dynamic coronary change mimicking dissection during angioplasty. Awareness of complex vessel morphology and specific PTCA hardware can prevent misdiagnosis and ensure optimal patient outcomes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Medical Device Technology
Background:
- Dynamic alterations in coronary artery configuration can occur during angioplasty.
- These changes may resemble extensive, complex dissections, potentially leading to misdiagnosis.
Abstract:
A series of angioplasty cases is presented in which dynamic alterations in coronary artery configuration developed. These changes were suggestive of extensive, complex dissections. Several common features emerged in these cases of which interventional cardiologists should be aware. These features included complex vessel morphology (tortuous segments, anomalous takeoffs, and complex stenoses) and the use of certain types of PTCA hardware (Amplatz guiding catheters and 0.018-inch wires). This phenomenon, termed pseudo narrowing, remains largely unrecognized. Identification of these characteristics and employment of proper management strategies will ensure a good outcome in these situations when they arise.