Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion
A 48-year-old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion. During primary percutaneous coro...
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Case Reports in Cardiology |
| Online Access: | http://dx.doi.org/10.1155/cric/1091601 |
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| author | Hiroshi Abe Tadao Aikawa Ken Yokoyama Tohru Minamino |
| author_facet | Hiroshi Abe Tadao Aikawa Ken Yokoyama Tohru Minamino |
| author_sort | Hiroshi Abe |
| collection | DOAJ |
| description | A 48-year-old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion. During primary percutaneous coronary intervention (PCI), a 0.014-inch floppy guidewire could not be easily advanced into the middle RCA due to poor backup support from the guiding catheter and the patient’s breathing. The pressure was monitored several times after reinserting the guiding catheter. Nevertheless, the guidewire was inadvertently inserted into the false lumen from the ostium, leading to subsequent dissection during contrast injection. Intravascular ultrasound (IVUS) imaging confirmed dissection from the ostium to the middle RCA and passage of the guidewire into the false lumen. An additional guidewire was successfully inserted into the true lumen of the RCA using real-time IVUS-guided wiring. We demonstrated successful bailout stenting for catheter-induced dissection of the nondominant small RCA. Our case highlights the risk of coronary artery dissection associated with guiding catheter use, especially in a nondominant small RCA, and the importance of optimal guiding catheter selection for primary PCI. The real-time IVUS-guided wiring technique can be applied to a single 6-Fr guiding catheter and is useful for quickly inserting a guidewire into the true lumen. |
| format | Article |
| id | doaj-art-88d5556b9fef4da788ad17f987c28a3c |
| institution | Kabale University |
| issn | 2090-6412 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Cardiology |
| spelling | doaj-art-88d5556b9fef4da788ad17f987c28a3c2024-12-24T00:00:02ZengWileyCase Reports in Cardiology2090-64122024-01-01202410.1155/cric/1091601Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery OcclusionHiroshi Abe0Tadao Aikawa1Ken Yokoyama2Tohru Minamino3Department of CardiologyDepartment of Cardiovascular Biology and MedicineDepartment of CardiologyDepartment of Cardiovascular Biology and MedicineA 48-year-old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion. During primary percutaneous coronary intervention (PCI), a 0.014-inch floppy guidewire could not be easily advanced into the middle RCA due to poor backup support from the guiding catheter and the patient’s breathing. The pressure was monitored several times after reinserting the guiding catheter. Nevertheless, the guidewire was inadvertently inserted into the false lumen from the ostium, leading to subsequent dissection during contrast injection. Intravascular ultrasound (IVUS) imaging confirmed dissection from the ostium to the middle RCA and passage of the guidewire into the false lumen. An additional guidewire was successfully inserted into the true lumen of the RCA using real-time IVUS-guided wiring. We demonstrated successful bailout stenting for catheter-induced dissection of the nondominant small RCA. Our case highlights the risk of coronary artery dissection associated with guiding catheter use, especially in a nondominant small RCA, and the importance of optimal guiding catheter selection for primary PCI. The real-time IVUS-guided wiring technique can be applied to a single 6-Fr guiding catheter and is useful for quickly inserting a guidewire into the true lumen.http://dx.doi.org/10.1155/cric/1091601 |
| spellingShingle | Hiroshi Abe Tadao Aikawa Ken Yokoyama Tohru Minamino Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion Case Reports in Cardiology |
| title | Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion |
| title_full | Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion |
| title_fullStr | Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion |
| title_full_unstemmed | Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion |
| title_short | Successful Bailout of Catheter-Induced Dissection in Acute Myocardial Infarction Resulting From a Nondominant Right Coronary Artery Occlusion |
| title_sort | successful bailout of catheter induced dissection in acute myocardial infarction resulting from a nondominant right coronary artery occlusion |
| url | http://dx.doi.org/10.1155/cric/1091601 |
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