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Right Coronary Artery Dissection
Caused by Catheter: a Case Report
Xiaozeng Wang Haiwei Liu
and Yaling Han
Department of Cardiology,
Shenyang Northern Hospital
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64-year-old male ; ID : 2163956
Chest pain for 10 months,
worsen for two months ;
Hypertension for 15 years ,
No history of diabetes ;
ECG : no ST-T segment changes
Case presentation
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LCA 及 RCA 动脉粥样硬化改变, RCA 造影管与 RCA 近段成角,同轴差
Feb 26, 2009 SCA : Initial angiography demonstrating atherosclerosis changes in LCA and RCA. Angularity was viewed between the angiography catheter and the proximal RCA, without ideal co-axis.
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RCA dissection formation from the proximal to the distal part of the vessel
Feb 26, 2009 SCA
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The National Heart, Lung and Blood Institute (NHLBI) Type A 血管腔内出现小的可透过区,对比剂通过即消失 dissections represent minor radiolucent areas within the coronary
lumen during contrast injection with little or no persistence of contrast after the dye has cleared.
Type B 血管腔内对比剂滞留,平行于管壁,几个周期后消失 dissections are parallel tracts or a double lumen separated by a
radiolucent area during contrast injection, with minimal or no persistence after dye clearance.
Type C 夹层突出于管壁外,对比剂通过后仍持续存在 dissections appear as contrast outside the coronary lumen
(“extraluminal cap”) with persistence of contrast after dye has cleared from the lumen.
Type D 螺旋型夹层,伴与不伴对比剂滞留 dissections represent spiral (“barber shop pole”) luminal filling
defects, frequently with excessive contrast staining of the dissected false lumen.
Type E 持续管壁充盈缺损,伴有远端血管对比剂滞留 dissections appear as new, persistent filling defects within the
coronary lumen. Type F 管腔充盈缺损,伴有管腔完全闭塞 dissections represent those
that lead to total occlusion of the coronary lumen without distal antegrade flow.
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• NHLBI classification system for coronary artery dissection types.
• Types A and B are generally clinically benign,
• types C through F portend significant morbidity and mortality if untreated.
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Strategy
Spiral dissection of the right coronary artery from the proximal to the distal part of the vessel, it is a NHLBI type D dissection, so select PCI with deployment stent
had no angina and hemodynamic instability, no need for IABP implantation and emergency CABG.
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JR3.5, BMW 导丝, RCA 近段置入 Excel 4.0x18mm 支架
PCI for RCA JR3.5, BMW guide wire , Stent Excel 4.0x18mm was implanted
in the proximal part of the RCA
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RCA 近中段再次置入 Excel 4.0x24mm 支架,与前一支架重叠 2mm
PCI for RCA The second stent Excel 4.0x24mm was implanted in the p-m RCA. Two
stents were overlapped with 2mm
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RCA 远段夹层处置入 Accrua 3.0x20mm 支架 ;RCA 远段可见血栓影像,单纯支架囊扩张消失
PCI for RCA Stent Accrua 3.0x20mm was implanted in the distal part of RCA; Thrombus
image was found in the distal part of the RCA, and disappeared with the stent balloon dilatation
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RCA 中段置入 Accrua3.5x20mm 支架,与远段支架不相连,并支架内整形,最终造影结果满意。
Stent Accrua3.5x20mm was implanted in the m RCA. It was not linked with the distal stent. The final angiogram was excellent.
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Final angiography at the end of the procedure
PCI for RCA
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Follow-up Double oral anti-platelet therapy for eight months
(clopidogrel 75mg plus aspirin 100mg once daily)
Follow-up Coronary Angiography (Oct 20, 2009) : No restenosis was found in RCA, TIMI grade 3 flow
Current oral medical therapy: aspirin 100 mg once
daily, antihypertensive medical and atorvastatin
There was absence of angina, and a normal ECG
was detected
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Coronary AngiographyOct 20, 2009
No restenosis was found in RCA
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Atherosclerosis changes in LCA
Coronary AngiographyOct 20, 2009
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Lessons and comprehends
Catheter-induced coronary dissection
can be formed in “normal” look liked
coronary artery
Stent implantation should be from the
distal to the proximal of the dissection
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