Juxtaposition of urgent angioplasty results in spontaneous coronary artery dissection: a case report of fresh vs. organized intramural haematoma

Figures

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  Figure 1. (I) Baseline angiogram of the left coronary system, (II) follow-up angiogram demonstrating disease progression in the context of intermittent chest pain and inferolateral ECG changes, and (III) post-PCI angiography.

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  Figure 2. Intravascular IVUS in the first patient at the index procedure (I) and at the second presentation with reinfarction (II). Image (I) demonstrates the true lumen (A, yellow) and false lumen (B, blue). Image (II) demonstrates the true lumen (A, yellow), partially organized thrombus with mixed hypo-anechogenic appearance (C, green), and fresh hyper-echogenic thrombus (D, red).

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  Figure 3. Images from the second case demonstrating initial angiography of the right coronary artery (A), placement of a stent (B), sealing of the aortic intramural haematoma (red arrow) (C), final result after extensive stenting with tooth-pasting appearance distally (D), and IVUS (E) demonstrating the true lumen (I) and false lumen (II).

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  Figure 4. Comparison of false lumen appearances in Patient 1 at two different time points and in Patient 2. In Patient 1, there is clear evolution from a completely fully anechogenic false lumen at Day 3 to a mixed appearance (ranging from hyper-echogenic fresh thrombus to hypo-anechogenic organized thrombus) in line with a thrombotic evolution of the false lumen at Day 9. In Patient 2, and in a more acute phase (Day 0), the false lumen presents appearances ranging from an-echogenicity to echogenicity quite close to the one true lumen, suggesting the presence of fluid blood component, more prone to ‘tooth-pasting’ phenomenon.

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  Figure 5. Follow-up IVUS (left) and angiography (right) in case 1, demonstrating significant stent malapposition which is not obvious on angiography alone.