Key points are not available for this paper at this time.
Introduction The use of intravascular ultrasound (IVUS) imaging is focal during both diagnostic and interventional coronary angiography, especially in complex cases that involve dissections. This case describes a 63-year-old male patient who was experiencing angina for over a year. Past medical history of note included a previous anterior myocardial infarction in 2020 treated with two stents to the left anterior descending (LAD) artery. An elective diagnostic angiogram demonstrated a moderate proximal lesion in the RCA to approximately 60%. He then returned for an elective pressure wire to the RCA with possible intervention. He had reported suffering from crescendo and resting angina for a few days' prior. Method During the coronary angiography a Judkins Right (JR4) guide catheter was used to engage the RCA and it was noted that there was an atheromatous dissection at the point of the lesion with thrombus. Wiring the RCA was firstly attempted with a Runthrough extra floppy wire, yet it was clear that the dissection extended to the distal vessel. Second step was to try with an Olive wire to avoid the false lumen. IVUS imaging was performed which identified the wires in a large dissection false lumen. With the IVUS catheter in the false lumen, a third Runthrough extra floppy wire was successfully introduced in the true lumen. IVUS demonstrated that the dissection extended from the crux of the RCA to the ostium. Subsequently, four overlapping Onyx Frontier stents were deployed sealing the dissection. Results The final IVUS run showed all the stents were well apposed along the RCA. The final angiographic result looked excellent with TIMI III distal flow and the ECG was reassuring too. Both the LAD and left circumflex artery did not show significant disease. He was monitored in hospital overnight and then discharged home. Conclusion Dissections are known complications during coronary angiography and/or percutaneous intervention. These can be iatrogenic, traumatic, or spontaneous, with different aetiologies and management pathways. IVUS can be of a great significance in guiding the management of such a complication from identifying the true and false lumens, aiding in the wiring and measurements of the lesion. Conflict of Interest None
Gaglani et al. (Mon,) studied this question.