Image in cardiology

Catheter-induced coronary dissection during optical coherence tomography investigation

EuroIntervention 2012;7:1124-1125. DOI: 10.4244/EIJV7I9A179

David Smith
David K. Smith, BSc MBBS MRCP; Hamed Bourenane; Julian W. Strange, MB ChB MRCP MD; Andreas Baumbach, MD FRCP FESC; Thomas W. Johnson*, BSc MBBS MRCP MD
Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
A 58-year-old lady presented with atypical chest pain, anterior ECG changes and troponin elevation. Coronary angiography, via the radial artery, delineated unobstructed right and circumflex coronaries but ectasia and delayed contrast clearance within the mid-LAD, suggestive of spontaneous coronary dissection (Figure1). An OCT study was undertaken to confirm the diagnosis. Vessel tortuosity prevented passage of the OCT catheter to the mid vessel despite aggressive guide intubation. OCT evaluation of the proximal LAD, using a pump-assisted contrast flush (20ml contrast injection at 3ml/sec [300 psi]) , revealed no significant arterial pathology. However, on catheter withdrawal an extensive proximal-vessel dissection was evident. The ...

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