Key result
Dual OCT-IVUS guidance with double wiring enables successful true lumen stenting in complex iatrogenic dissection.
Why the study?
Iatrogenic coronary artery dissection is a serious PCI complication where wiring the true lumen is often difficult, requiring improved guidance techniques.
Case Report (n=1)
A double-wiring technique combined with OCT and IVUS imaging can successfully guide true lumen wiring and stenting in complex iatrogenic coronary artery dissections.
Case demonstrates feasible true-lumen recanalization in spiral ICAD; leaves open optimal techniques pending larger series.
Background: Iatrogenic coronary artery dissection (ICAD) may represent a serious complication of percutaneous coronary intervention. Stenting the dissected segment is recommended in large dissections with compromised distal blood flow, although wiring the true lumen is often difficult. Case summary: A 64-year-old woman with effort angina was submitted to invasive coronary angiography that revealed a severe stenosis in the distal right coronary artery. A large spiral ICAD occurred after pre-dilatation and guidewire position is lost. We report the treatment of this multifenestrated dissection using combined intracoronary imaging guidance with angiographic co-registered optical coherence tomography and real-time intravascular ultrasound, which were crucial to achieve a successful outcome. Discussion: A double-wiring technique with double intracoronary imaging guidance enables a comprehensive depiction of the compromised artery and should be considered in selected cases to guide true lumen wiring and stent implantation.
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Viegas et al. (2023) conducted a case report in Iatrogenic coronary artery dissection (n=1). Double-wiring technique with double intracoronary imaging guidance (OCT and IVUS) was evaluated on Successful treatment of multifenestrated dissection (true lumen wiring and stent implantation). A double-wiring technique with combined optical coherence tomography and intravascular ultrasound guidance successfully facilitated true lumen wiring and stent implantation in a multifenestrated iatrogenic coronary artery dissection.
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