Subintimal Dissection of the Coronary Arteries

Selective coronary arteriography is now the procedure of choice in the determination of the existence and the delineation of the extent of chronic obstructive coronary artery disease. Since Sones and Shirey's original description of this technique, variations in the procedure and the approach have evolved. More recently, the percutaneous transfemoral artery approach to selective coronary arteriography has gained increasing favor because of the ease of intubation of both coronary arteries, stability of the catheter once positioned in the coronary ostium, and the high quality of cinefluorography and direct serial radiography. Because of the tapered-tip design and positrol feature, the depth to which the coronary artery can be cannulated, and the angle formed by the tip of the catheter and the intima of the vessel, the possibility of subintimal dissection of the coronary arteries as an inherent complication of this approach arises. Two such cases of subintimal dissection of the left coronary artery are described with cinefluorographic documentation. It is recommended that after cannulation of the coronary vessels the catheter be withdrawn several millimeters from the lumen of the vessel in order to avoid this complication of an otherwise valuable diagnostic approach to selective coronary arteriography.