Key Points
- To describe the mechanism and clinical occurrence of subintimal coronary artery dissection during selective coronary arteriography performed via the percutaneous transfemoral artery approach.
- Evaluated procedural complications associated with catheter tip design, intraluminal depth, and vessel wall angle during selective coronary arteriography.
- Analyzed cinefluorographic and radiographic documentation from N=2 clinical cases experiencing catheter-induced left coronary artery injury.
- Identified that deep cannulation, tapered catheter tips, and steep entry angles relative to the intima caused left coronary artery subintimal dissection in both cases.
- Demonstrated that withdrawing the catheter several millimeters from the lumen immediately after ostial engagement prevents mechanical intimal disruption while preserving diagnostic image quality.
Structured PICO
PPopulation2 patients undergoing selective coronary arteriography via the percutaneous transfemoral artery approach
IInterventionPercutaneous transfemoral artery approach to selective coronary arteriography
OOutcomeSubintimal dissection of the left coronary arterysafety
The percutaneous transfemoral approach to coronary arteriography carries a risk of subintimal dissection, which can be mitigated by withdrawing the catheter slightly after cannulation.