19: Coronary Dissection Involving the Aortic Root

CASE 19 Coronary Dissection Involving the Aortic Root





Cardiac catheterization


Diagnostic catheterization found normal left ventricular function and significant stenoses in the proximal segment of the right coronary artery (Figure 19-1 and Video 19-1) and in the left anterior descending artery (Figures 19-2, 19-3 and Video 19-2). The left circumflex artery appeared angiographically normal. Coronary calcification was noted in both the right coronary and left anterior descending arteries. After discussing the options of medical therapy, coronary bypass surgery, and percutaneous coronary intervention, the patient chose a percutaneous revascularization strategy.





After administration of a bolus of 70 U/kg of unfractionated heparin followed by a double bolus and infusion of eptifibatide, the operator first approached the left anterior descending artery. The lesion was first dilated with a balloon and then treated with a sirolimus-eluting stent (Figure 19-4). The operator then turned attention to the right coronary artery. Anticipating the need for extra backup to support the intervention, due to the presence of coronary calcification noted on the diagnostic study, the operator chose a left Amplatz guide catheter (AL-2), as shown in Video 19-1. Although this guide catheter appeared to provide excellent support, pressure damping and retention of contrast in the arterial wall was observed in the proximal segment consistent with a guide-related dissection, leading to the exchange of the Amplatz guide for a right Judkins guide catheter. Upon engagement, the physician noted distal extension of the dissection, with retention of contrast nearly to the bifurcation of the posterior descending and posterolateral branches (Figure 19-5

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Jun 11, 2016 | Posted by in CARDIOLOGY | Comments Off on 19: Coronary Dissection Involving the Aortic Root

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