Combined dissection of the right coronary artery and right coronary cusp during coronary angiography

Abstract

Dissection of coronary arteries during diagnostic coronary angiography is infrequent; dissection of the coronary cusp is extremely rare. The combination of coronary artery and coronary cusp dissection has not been reported previously. A case of right coronary artery dissection and right coronary cusp dissection during diagnostic coronary angiography is described.

Iatrogenic coronary artery dissections extending into and involving the aortic root

“…Coronary artery dissection after PCI occurs in 20 -40% of cases [1] whereas in coronary angiography the incidence is Ͻ0.1% [3]. A total of 17 previous cases of iatrogenic aortic root dissection during cardiac procedures have been reported [2][3][4][5][6][7][8][9][10][11]. One study of thoracic and abdominal aortic dissection during radiology procedures described 6 cases from the records of 15,500 angiographic procedures, for an incidence of 0.04% [12].…”

“…Rarely, dissection involving the aortic root may also develop (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In a report on 21,000 coronary angioplasties representing the combined experience of several interventional cardiologists, there were four acute aortic dissections for an incidence of 0.02% [6].…”

Imaging of left main trauma during diagnostic cardiac catheterization with intravascular ultrasound

“…The mechanisms possibly responsible for coronary artery dissection at angiography are atherosclerotic disease, vigorous contrast injection and direct catheter trauma. 5 Medial degeneration and catheter size may also be important. 6 Spontaneous coronary artery dissection occurs more frequently with the right coronary artery and results in myocardial infarction in approximately two-thirds of the patients.…”

Aortic dissection as a rare complication of percutaneous coronary intervention

“…The origin of this dissection may be in the aortic root or coronary ostium 10. The precise mechanism remains unknown and it is suspected to occur due to forceful use of a catheter or guide wire, vigorous injection of dye or underlying degeneration of the aortic wall 8 11 12. Aortic dissection is more common during interventions of the RCA than left coronary artery and may be due to its comparatively thin wall, tortuous anatomy and small size 13 14…”