Unusual Complication of Retrograde Dissection to the Coronary Sinus of Valsalva During Percutaneous Revascularization

Yip, Hon‐Kan; Wu, Chiung‐Jen; Yeh, Kuo-Ho; Hang, Chi‐Ling; Fang, Chiung‐Yao; Hsieh, Kelvin; Fu, Morgan

doi:10.1378/chest.119.2.493

Cited by 84 publications

(100 citation statements)

References 25 publications

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“…Therefore, it is not surprising that these shearing forces of blood flow during systole and diastole may also explain the antegrade and retrograde propagation of the dissection. 5) This resembles the mechanism that causes aortic dissection in hypertensive patients. Third, side branches rising from the epicardial vessels may be able to retard the propagation of coronary dissection.…”

Section: Discussionmentioning

confidence: 81%

“…4,5) This study reviewed our experience and found that 3 patients undergoing diagnostic cardiac catheterization and 14 patients undergoing PCI simultaneously developed antegrade and retrograde dissection of the RCA. All of these dissections developed during engagement of the RCA by the guiding catheters.…”

Section: Discussionmentioning

confidence: 99%

“…This mechanism, derived from the angiographic observations in the subject patients, was also proposed by previous investigators. 4,5,[13][14][15] Second, the blood supply to the RCA is well known to occur during both the systolic and diastolic phases. Therefore, it is not surprising that these shearing forces of blood flow during systole and diastole may also explain the antegrade and retrograde propagation of the dissection.…”

Section: Discussionmentioning

confidence: 99%

“…4) Extensive dissection of the RCA may be life-threatening, and patients with this clinical setting may face the potential risk of nonfatal myocardial infarction, emergency surgery, or even a fatal outcome. 4,5) Therefore, learning and mastering how to promptly manage this complication is crucial for interventional cardiologists. 5) However, coronary intervention for this complication is usually a formidable challenge for cardiologists if the dissection point is at or near the ostium of the RCA.…”

mentioning

confidence: 99%

“…4,5) Therefore, learning and mastering how to promptly manage this complication is crucial for interventional cardiologists. 5) However, coronary intervention for this complication is usually a formidable challenge for cardiologists if the dissection point is at or near the ostium of the RCA. This is because the guiding catheter is always engaged into the proximal RCA beyond the dissection point and into the false lumen.…”

mentioning

confidence: 99%

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Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms

Chai

Yang

et al. 2005

Int. Heart J.

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SUMMARYWhile coronary artery dissection caused by a guiding catheter, which is one of the most commonly occurring complications during diagnostic cardiac catheterization or coronary intervention, has various forms, extensive antegrade and retrograde dissections of the right coronary artery (RCA) are rarely observed during these procedures.Within the last three years, we retrospectively reviewed our experience with 12,600 consecutive patients who underwent either diagnostic cardiac catheterization or coronary angioplasty, and found that 17 (0.14%) of the patients displayed extensive antegrade and retrograde RCA dissection. The antegrade dissection always propagated to the distal RCA either on bifurcation of the posterior descending artery and posterolateral artery (PLA) or to the proximal PLA. The retrograde dissection was always observed close to the ostium of the RCA or extending to the ostium of the RCA. TIMI-0 flow in the RCA was immediately observed in all the patients. Chest pain associated with an electrocardiogram showing ST-segment elevation was soon observed in most of the patients. The true lumen could be entered successfully using a single wire in 8 of 17 patients. However, a doublewire technique was required for 7 patients. This technique involved first advancing a wire along to the false lumen and then pulling back the guiding catheter away from the ostium of the RCA for a few millimeters followed by anchoring with the wire. Another wire was then gently inserted into the true lumen from the dissection entrance point, which was located near or at the ostium of RCA, and carefully advanced to the distal RCA. Coronary stenting was successfully deployed in 15 patients. However, the procedure failed in 2 patients. Furthermore, this complication caused 7 patients to have acute myocardial infarctions, 2 patients to develop atrial fibrillation, and 1 to die from ischemic enterocolitis due to cardiac embolism after 7 months of follow-up. In conclusion, with an increase in experience, we now better understand this complication. However, this complication, which is a formidable challenge for coronary intervention, may be a life-threatening complication, and patients with this complication may face the potential risk of a nonfatal From the

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms

Chai

Yang

et al. 2005

Int. Heart J.

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Migrating type a intramural hematoma after repair of an anomalous right coronary artery aortocoronary dissection with a covered stent

Fang

2011

Cathet Cardio Intervent

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Treatment of aortocoronary dissection complicating anomalous origin right coronary artery and chronic total intervention with intravascular ultrasound guided stenting

Abdou

2011

Cathet Cardio Intervent

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Acute dissection of the ascending aorta is a rare complication of percutaneous coronary intervention (PCI). Its mechanism involves disruption of the coronary intima by mechanical trauma, followed by subintimal injection of contrast, which, in turn, contributes to subsequent extension of the dissection. In contrast to spontaneous aortic dissection of ascending aorta, which mandates immediate surgical intervention, the appropriate therapy and outcome of this rare entity are not well established. We report a case of iatrogenic aortocoronary dissection, complicating transradial PCI for recanalization of anomalous origin right coronary artery (RCA) from the left coronary cusp with chronic total occlusion. The intimal tear was created by a balloon rupture in the proximal RCA, with propagation of dissection into the ostium and the coronary sinus of Valsalva. Intravascular ultrasound (IVUS) guided coronary stenting was performed to seal the entry port, and to break down the dissection route. This case indicates that IVUS can be a useful tool to ensure complete coverage of the intracoronary dissection and precise placement of the stent to fully cover the ostium of the culprit vessel. This can be particularly important in difficult situations, such as anomalous origin of RCA from the left cusp, with acute downward anterior angulation.

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Unusual Complication of Retrograde Dissection to the Coronary Sinus of Valsalva During Percutaneous Revascularization

Cited by 84 publications

References 25 publications

Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms

Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms

Migrating type a intramural hematoma after repair of an anomalous right coronary artery aortocoronary dissection with a covered stent

Treatment of aortocoronary dissection complicating anomalous origin right coronary artery and chronic total intervention with intravascular ultrasound guided stenting

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