Adenosine
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Worsening of coronary artery dissection: case report A 63-year-old woman developed worsening of coronary artery dissection while receiving adenosine for fractional flow reserve. The woman, who had type II diabetes mellitus, presented with unstable angina pectoris. ECG findings showed a new T wave inversion. Initially, she received unspecified medical treatment for 1 month and then decided to undergo coronary catheterisation. An elective coronary angiography showed a moderate lesion at the proximal-mid-left anterior descending coronary artery (LAD) with a remarkable long lesion at the ostial-mid of the main major-obtuse marginal branch (OM). Hence, it was decided to interrogate her with the fractional flow reserve (FFR) method. She was hospitalised. Initially, she received intracoronary adenosine at a dose of 60µg (5mL), followed by a second dose of intracoronary adenosine 120µg (10mL). Her FFR was 0.91. However, her FFR reduced to 0.66 following the third bolus dose of 180µg (15mL) of intracoronary adenosine. She also developed haemodynamic instability. At that time, her BP and HR were 76/45mm Hg and 46 beats/min, respectively. Subsequent coronary angiography showed dissection of the mid-distal LAD with thrombolysis in myocardial infarction (TIMI) 2 flow. Her coronary artery dissection was found to be induced by FFR coronary wire, which was further worsened by the injection of adenosine [time to reaction onset not stated]. The woman received 2 doses of intracoronary epinephrine [adrenaline] to increase her BP to 83/56mm Hg. Thereafter, a Trek balloon was inflated at the dissected mid-distal LAD segment, followed by pre-dilatation with a sequent please paclitaxel-coated balloon for 1 minute. The subsequent angiogram showed instant sealing of the dissection flap with the restoration of TIMI 3 flow. At a 1 month follow-up, the LAD segment had healed nicely. Thereafter, pre-dilatation was achieved by Trek balloon followed by prolonged inflation with a paclitaxel-coated balloon for 1 minute. An excellent pre-dilatation result was obtained with minimal lumen recoil. Yew KL. Successful treatment of fractional flow reserve wire induced coronary dissection and other coronary de novo lesion with paclitaxel coated balloon only. International 803515189 Journal of Cardiology 177: 1127-1128, No. 3, 20 Dec 2014. Available from: URL: http://doi.org/10.1016/j.ijcard.2014.08.056
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