RN

History:Female, 54 yoChief complain: paroxysmal chest distress for 1 monthRisk factors: uncontrolled hypertension Examination and basic therapyBp: 160/80 mmHgHeart and lung: normalECG: NormalEcho: LA 34 mm, LV 48 mm, EF 75% Diagnosis:Coronary heart diseaseUnstable angina pectorisEssential hypertension grade 2 Drug therapy:Telmisartan 40 mg QDAspirin 80 QDTicagrelor 75 mg BIDAtorvastatin 20 mg QDBisoprolol 2.5 mg QD

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Diagnostic coronary angiographymLAD stent patentOM2 80%pRCA 80%
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According the result of CAG, decided to intervene RCAApproach: Trans-right Radial ArteryGC: 6FJR3,5GW:0.014BMWBalloon:  pre-dilated balloon: SEQUENT NEO 3.5x20mm;  post-dilated balloon: NC SAPPHIRE 4.5 x 18 mmStent:  COROFLEX ISAR 4.0x24mm  XLIMUS 3.5 x 36 mm   XLIMUS 4.0 x18 mm  VASMED 4.0 x 18 mm
After ballooning mRCA by SEQUENT NEO  3,5 x20 mm at 8 atm, the mRCA is totally occluded, AMI occurred. No flow phenomenon. The patient is in severe dangerous status. The patient began to have angina. Time is urgent.At the crucial time, what to do? How to do to avoid the disaster?Ok, let’s study the angiography film carefully, Maybe we can find a way. There is spiral dissection from mRCA to dRCA. we have to stent to seal the dissection of mid RCA.
Strategy of treatment for the dissectionExperience:We deployed an COROFLEX ISAR EXCEL3.5x24mm at mRCA, in order to seal port d entry dissection. Then We deployed a second stent XLIMUS 3,5x36 mm at dRCA, a third VASMED 4.0x18 mm at m-dRCA and fourth XLIMUS 4.0 x 40 mm at p-mRCA, respectively. Post dilated with NC SAPPHIRE 4.0 x 18mm at 12-24 atm. The RCA flow was regained.
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The spiral dissection that occurred in this case was due to the balloon procedure.The dissection that occurred in this case caused flow disturbance and even total occlusion.Spiral dissection can be treated by inserting a stent.