Multislice Computed Tomography for Preinterventional Mapping of Complicated Coronary Artery Injury
A 72-year-old man was referred to our emergency department from another hospital because of a coronary complication that occurred during coronary angiographic examination for suspected chronic stable angina 1 day previously. Although angina progressed, there was no evidence of myocardial infarction by enzyme markers or ECG. To investigate the complicated coronary artery safely and precisely before rescue intervention, 16-slice computed tomography (CT) was acquired with 0.75-mm-thick slices and ECG gating after an intravenous injection of contrast medium. Multiplanar reformations revealed a long spiral dissection over the right coronary artery (Figure 1) with overt double lumens extending from the orifice to the middle portion of the artery (Figure 2). The entrance point was identified at the orifice; the true lumen was 3.05 mm and the false lumen was 1.22 mm, and a >95% ostial stenosis caused by the intimal flap was noted (Figure 1). The other vessels showed no significant stenosis. An emergent catheterization was carefully undertaken directly to the right coronary artery, which confirmed the diagnosis (Figure 3). An NIR stent (3.0×23 mm at 18 atm) was deployed, which completely occluded the false lumen successfully. A follow-up CT 3 weeks later showed good position and patency of the stent (Figure 4) and complete obliteration of the false lumen.
Multislice CT coronary angiography is useful in preinterventional mapping of complicated coronary lesions.
This research was supported in part by the National Science Council under grant NSC- 93-2314-B-75B-007.