(Circulation. 1999;99:E17.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
Intracoronary Ultrasound Longitudinal Reconstruction of a Postangioplasty Coronary Artery Dissection
I. Patrick Kay, MBChB;
Manel Sabate, MD;
Jurgen M. R. Ligthart, BSc;
Willem J. van der Giessen, MD, PhD;
Pim J. de Feyter, MD, PhD;
Patrick W. Serruys, MD, PhD
From the Thoraxcenter, Academisch Ziekenhuis Rotterdam, Netherlands.
Correspondence to I.P. Kay, Department of Interventional Cardiology, Thoraxcenter, Academisch Ziekenhuis Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
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Introduction
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 Top
 Introduction
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A62-year-old woman
presented with unstable angina. Angiography
demonstrated a
severe stenosis in the distal right coronary
artery
(RCA), and angioplasty with stent implantation was undertaken.
This was
complicated by a coronary artery dissection distal
to the stent
that was detected by angiography and intracoronary
ultrasound
(ICUS).
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Figure 1. Coronary angiogram (left anterior oblique
projection) demonstrates a longitudinal dissection proximal to
bifurcation of right coronary artery into posterior descending
and posterolateral arteries. Inset, ICUS catheter is in posterolateral
branch; contrast staining is present inferior to artery
(arrow). ICUS was performed at this site with a 30-MHz transducer
mounted on a 2.9F catheter (Microview, Boston Scientific-CVIS).
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Figure 2. Longitudinal reconstruction of dissection: letters
A through C correspond to ICUS transverse sections of accompanying
images. In following images, proximal vessel is denoted by a, where
both normal and slow blood flow are seen in a double-barreled lumen; b
corresponds to transverse section, where blood/contrast interface is
seen; and a' denotes area where only contrast within false lumen is
seen. Note that artery bifurcates, with ICUS catheter present in
posterolateral vessel. Distal dissection stops short of posterior
descending artery.
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Figure 3. Classic double-barreled lumen is seen, with a flap
denoted by arrow. Lumen (b) has normal blood flow, whereas flow in a is
decreased.
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Figure 5. A subintimal dissection with an echolucent
contrast–filled false lumen (a) is seen. Arrows denote cardiac veins
and are not associated with dissection. Because there was grade 3
Thrombolysis in Myocardial Infarction (TIMI) flow,
satisfactory lumen dimensions, and concern over proximity of dissection
to RCA bifurcation, no further intervention was undertaken. Patient
remains well at 6-month follow-up.
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Acknowledgments
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Dr Kay was supported by the National Heart Foundation of
New
Zealand.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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The pattern of restenosis and vascular remodelling after cold-end adioactive stent implantation
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[Abstract]
[PDF]
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