Serial examinations of right coronary artery directly injured by radiofrequency catheter ablation with optical coherence
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CASE REPORT
Serial examinations of right coronary artery directly injured by radiofrequency catheter ablation with optical coherence tomography and intravascular ultrasound Makoto Araki1 • Tetsumin Lee1 • Tadashi Murai1 • Tsunekazu Kakuta1
Received: 11 August 2015 / Accepted: 4 November 2015 Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract A 42-year-old man was referred for ablation. The origin of VT was localized close to the right coronary ostium. During ablation, the catheter tip inadvertently fell into a RCA ostium. The patient developed chest discomfort and ST-segment elevation in the inferior leads was observed. Coronary angiography confirmed severe narrowing of the ostial RCA. Stenting was deferred after satisfactory dilatation by a balloon. The patient discharged with eventless clinical course afterward. Follow-up coronary angiographic, FD-OCT, IVUS, and iMap examinations were performed at 3, 6, and 15 months after index procedure. The lesion showed progressive positive remodeling associated with intimal proliferation, medial thickening, and lumen narrowing up to 6 months. The patient underwent stenting at 15 months after the index procedure. The lesion required high-pressure post dilatation to obtain optimal stent expansion. Keywords Catheter ablation Complication Coronary artery injury PCI FD-OCT IVUS A 42-year-old man with a history of a previous unsuccessful endocardial ablation of recurrent, drug-resistant VT was referred for a redo ablation. Following the activation and pace mapping, the origin of VT was localized close to
Electronic supplementary material The online version of this article (doi:10.1007/s12928-015-0368-7) contains supplementary material, which is available to authorized users. & Tsunekazu Kakuta [email protected] 1
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Manabeshin-machi 11-7, Tsuchiura, Ibaraki 300-0053, Japan
the right coronary ostium. After control coronary angiography, radiofrequency energy using a quadripolar catheter with 4-mm non-irrigated distal electrode (Fantasista M/M curve, Japan Lifeline, Japan) for 80 s was repeated with the temperature limit set at 50 C and a power of 35 W. During RF application, the catheter tip inadvertently fell into a right coronary artery (RCA) ostium associated with cardiac and respiratory motion. The patient developed chest discomfort and ST-segment elevation in the inferior leads was observed. Coronary angiography confirmed severe narrowing of the ostial RCA (Fig. 1). After intracoronary nitroglycerin injection, chest discomfort disappeared and intravascular imagings using frequency domain optical coherence tomography (FD-OCT) (Ilumien Optis PCI Optimization System, St Jude Medical, St. Paul, MN, USA) and intravascular ultrasound (IVUS) (Boston Scientific, Natick, Massachusetts) indicated the presence of intimal thickening suggesting the combination of vasospasm, intimal disruption and edematous response, and intra-luminal thrombus formation (Figs. 2, 3). Ste
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