A case of delayed occlusive dissection of the right coronary artery during coronary intervention of the left anterior de
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CASE REPORT
A case of delayed occlusive dissection of the right coronary artery during coronary intervention of the left anterior descending artery Yoshiki Nagata • Michiro Maruyama • Isao Aburadani • Motoaki Hirazawa • Takuya Mayumi • Kazuo Usuda
Received: 14 September 2013 / Accepted: 5 April 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract Catheter-induced coronary artery dissection occurs rarely during selective coronary angiography but generally progresses to complete coronary occlusion. We present a case of delayed occlusive dissection of the right coronary artery during coronary intervention of the left anterior descending artery. Bailout stenting was employed to treat the giant hematoma quickly using a unique technique. The use of two guidewires created a high probability that the true lumen was selected, and aspiration of the hematoma with the microcatheter and indeflator effectively repaired a catheter-induced coronary artery dissection.
We present a case of delayed occlusive dissection of the right coronary artery (RCA) that occurred during coronary intervention at the left anterior descending artery (LAD). Stent-edge dissection of the LAD had not yet been treated. This double coronary artery dissection caused a lifethreatening situation. However, we employed a logical and unique bailout stenting technique to treat this complication. Our technique may be helpful to the coronary interventionist.
Case report Keywords Catheter-induced coronary artery dissection Microcatheter Stent
Introduction Cardiac catheterization is a relatively safe procedure but has a well-defined risk of morbidity and mortality. The risk of producing a major complication (myocardial infarction, major embolization, or death) during selective coronary angiography is generally well below 2 percent [1, 2]. The risk of myocardial infarction varies from 0 [1] to 0.06 % [3]. One of the causes of myocardial infarction is catheterinduced coronary artery dissection, which occurs very rarely during selective coronary angiography but generally progresses to complete coronary occlusion [4, 5].
Y. Nagata (&) M. Maruyama I. Aburadani M. Hirazawa T. Mayumi K. Usuda Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama 930-8550, Japan e-mail: [email protected]
The patient was a female in her early 50s with a medical history of duodenal ulcer. Her coronary risk factors were hypertension, dyslipidemia, and tobacco use. In April 2008, she had repeated episodes of anterior chest pain during exercise during the week prior to presentation. She was referred to our hospital because of resting chest pain lasting 2 h. Electrocardiogram performed in the emergency room showed ST depression in leads I, aVL, and V3–V6. Laboratory data revealed that troponin-T was positive (cut off value \0.014 ng/mL) and creatinine phosphokinase was elevated to 1,993 IU/L. She was diagnosed with acute coronary syndrome and emergent coronary a
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