Successful treatment by percutaneous stent deployment of severe retrograde dissection of the right coronary artery extending into the sinus of Valsalva and ascending aorta

Notaristefano, Salvatore; Giombolini, Claudio; Santucci, S.; Fortunati, Federico; Savino, Ketty; Notaristefano, Antonio; Ambrosio, Giuseppe

doi:10.1016/j.ijcard.2004.10.056

Cited by 8 publications

(12 citation statements)

References 6 publications

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“…We found 86 cases of aortic dissection caused by percutaneous coronary angiography or PCI (Table I). Ten of those occurred during attempted intervention on chronic total occlusion (Table II), 36,[47][48][49][50][51][52][53][54][55] and 7 were in patients who had histories of CABG (Table III). [56][57][58][59][60][61][62] Of the 86 cases, 26 (30.2%) occurred during emergency catheterization.…”

Section: Discussionmentioning

confidence: 99%

Aortic Dissection Caused by Percutaneous Coronary Intervention: 2 New Case Reports and Detailed Analysis of 86 Previous Cases

Shah¹,

Bajaj²,

Shamoon³

2016

Texas Heart Institute Journal

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A ortic dissection is a rare and potentially fatal sequela of percutaneous coronary intervention (PCI). The exact prevalence of aortic dissection after PCI is unknown, because occurrences might be unreported. The first case was reported in 1992. 1 We found 86 published instances 1-62 and have categorized these in detail. In addition, we present 2 new cases of aortic dissection consequent to PCI, and we discuss their specific treatment. Case Reports Patient 1A 52-year-old hypertensive man presented with acute inferior ST-segment-elevation MI (STEMI). He had a distant history of inferior myocardial infarction (MI) that had been treated with placement of a drug-eluting stent. At the current presentation, he was immediately taken for cardiac catheterization. Initial views of the left coronary system with use of a 6F Judkins left (JL)4 diagnostic catheter revealed no significant lesions. Views of the right coronary artery (RCA), examined with use of a 6F Judkins right (JR)4 diagnostic catheter, showed occlusion of the original proximal RCA stent. The diagnostic catheter was immediately removed, and a 6F JR4 guide catheter was used without difficulty to engage the RCA. A 180-cm Asahi Prowater Flex guidewire (Abbott Vascular, part of Abbott Laboratories; Abbott Park, Ill) was inserted into the RCA but could not cross the culprit lesion. This wire was exchanged for a 190-cm Hi-Torque Whisper guidewire (Abbott Vascular), and the lesion was successfully crossed with support from a 1.5 × 15-mm Maverick Over-the-Wire Balloon Catheter (Boston Scientific Corporation; Natick, Mass). Two brief inflations were done at pressures of 12 atm within the stent for 10 s each. The wire was upgraded to a 300-cm Asahi Prowater Flex wire while the Maverick balloon was still inside the artery. The patient reported chest pain, and his systolic blood pressure (SBP) fell to 78 mmHg. The balloon was removed. An angiogram showed dissection of the proximal RCA, extending retrograde into the right aortic cusp and ascending aorta (Fig. 1). In addition, slow flow and evidence of thrombus were noted in the RCA. A Pronto V3 extraction catheter (UDG Healthcare plc; Dublin, Ireland) was immediately inserted, and manual-aspiration thrombectomy was performed. Then, a 3.5 × 28-mm Vision ® bare-metal stent (Abbott Vascular), deployed in the proximal RCA at a pressure of 12 atm, was extended into the ostium to seal the dissection flap (Fig. 2).

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Section: Discussionmentioning

confidence: 99%

Aortic Dissection Caused by Percutaneous Coronary Intervention: 2 New Case Reports and Detailed Analysis of 86 Previous Cases

Shah¹,

Bajaj²,

Shamoon³

2016

Texas Heart Institute Journal

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“…Dissection of the CSV is a rare complication of PCI and may be associated with major adverse events when the dissection extends into the ascending aorta (Bae, Kim, Kim, & Kim, 1998;El-Jack, Pornratanarangsi, & Webster, 2006;Masaki et al, 2005;Notaristefano et al, 2005;Yip et al, 2001). In a retrospective review of 4,700 PCI cases from 1995 until 1999, Yip et al (2001) noted that CSV dissections occurred in seven (0.15%) patients, with 85.7% of these dissections occurring in the RCA.…”

Section: Discussionmentioning

confidence: 99%

Coronary Sinus of Valsalva Dissection and Acute Stent Thrombosis Resulting From a Balloon Rupture

Serwer

Andrews

Mackay

et al. 2011

Cardiac Cath Lab Director

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We present the case of a retrograde dissection of a right coronary artery (RCA) into the coronary sinus of Valsalva (CSV) attributed to a high-pressure jet extruding from a ruptured angioplasty balloon. The dissection was further complicated by an acute stent thrombosis. Both the CSV dissection and the acute stent thrombosis were successfully treated percutaneously using a combination of a Jo-Med Covered Stent and three bare metal stents. Case PresentationAn 83-year-old female developed chest pain and shortness of breath on postoperative day 3 after a total knee replacement. Her electrocardiogram revealed new-onset atrial fibrillation with a rapid ventricular rate and inferolateral ST segment depressions. She was treated with intravenous metoprolol for rate control and spontaneously converted to normal sinus rhythm after a few hours. She ruled in for a myocardial infarction with mildly positive Troponin I of 0.09 ng/dL. Her spiral computed tomography scan was negative for pulmonary emboli. The patient had a nuclear stress test that revealed inferior ischemia, and she was referred for coronary angiography.The patient's left coronary system revealed no significant disease, but her RCA coronary had an 80% to 90% stenosis in the ostial portion, followed by a 70% to 80% stenosis in the proximal vessel and a 40% to 50% stenosis in the mid vessel. The 4-French catheter dampened with each engagement of the RCA. The ostium of the RCA was calcified and highly angulated (Figures 1 and 2). Because of the patient's high-risk clinical and angiographic presentation, she was referred for a percutaneous coronary intervention (PCI).A 6-F JR4 Cordis guiding catheter was placed near the ostium of the RCA, which could not be engaged due to damping. A .014-in. PT2 wire was manipulated past the RCA lesions into the distal posterior descending coronary artery. The ostial and proximal RCA lesions were predilated with a 2.5 mm × 12 mm Sprinter balloon to 8 atm. A 70% to 80% residual stenosis remained in the ostial lesion, with a 60% to 70% residual in the proximal lesion; therefore, provisional stenting was employed. Because of the patient's advanced age, atrial fibrillation, and history of gastrointestinal bleeding, we decided to use overlapping bare metal stents. A 3.0 mm × 20 mm Liberte stent was deployed in the proximal RCA at 12 atm, and a second 3.0 mm × 20 mm Liberte stent was deployed at 14 atm in the proximal portion of the first stent, extending 2 to 3 mm out of the ostium of the RCA (Figure 3). A 3.0 mm × 15 mm Quantum Maverick balloon was used for high-pressure postdilatation. The Quantum Maverick was first inflated to 16 atm in the distal stent and then inflated to 16 atm in the ostial stent. After these first two inflations, no contrast was seen in the CSV (Figure 4). A third inflation to 14 atm was performed with the Quantum Maverick extending outside the ostial stent, in order to ensure the ostium was fully dilated. During this third inflation, the balloon was noted to lose pressure at approximately 14 atm, and was quickly...

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“…While some authors maintain that the best option is outright surgical repair, others report a strategy of "wait and see", with medical management only, or with stenting of the entry port with bare or covered stents, if the patient is stable and the dissection is limited to the sinus of Valsalva [2][3][4][5][6][7][8][9][10][11][12][13]. In the case reported here, dissection of the LMS involving the sinus of Valsalva was succesfully treated by delivering drug-eleuting stent up to the ostium of coronary vessel.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of severe retrograde dissection of the circumflex artery involving left main stem and extending into the sinus of Valsalva

Gasparini

Parenti

Rossi

et al. 2008

International Journal of Cardiology

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Successful treatment by percutaneous stent deployment of severe retrograde dissection of the right coronary artery extending into the sinus of Valsalva and ascending aorta

Cited by 8 publications

References 6 publications

Aortic Dissection Caused by Percutaneous Coronary Intervention: 2 New Case Reports and Detailed Analysis of 86 Previous Cases

Aortic Dissection Caused by Percutaneous Coronary Intervention: 2 New Case Reports and Detailed Analysis of 86 Previous Cases

Coronary Sinus of Valsalva Dissection and Acute Stent Thrombosis Resulting From a Balloon Rupture

Percutaneous treatment of severe retrograde dissection of the circumflex artery involving left main stem and extending into the sinus of Valsalva

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