Right Ventricular Failure Secondary to Right Coronary Artery Dissection Complicated by Impella Malfunction

Iatrogenic coronary artery dissection is a rare but potentially catastrophic complication of coronary angiography. Coronary artery dissection can lead to cardiogenic shock and cardiac arrest. A 54-year-old man presented with a non-ST-segment elevation myocardial infarction and was found to have severe stenosis of the obtuse marginal artery and right coronary artery. A spiral coronary artery dissection occurred during right coronary artery intervention, and the patient experienced cardiac arrest and right ventricular failure, requiring inotropic and mechanical circulatory support. The patient had a tortuous right coronary artery and a 6-F guiding catheter was used, both of which increased the risk of dissection. Acute right ventricular failure was treated with inotropic and mechanical circulatory support despite the patient having a faulty Impella sensor. Iatrogenic coronary artery dissection is a rare complication that can be treated with stenting, and subsequent cardiogenic shock can be managed with inotropic and mechanical circulatory support.