CORONARY - Complications
Waiting for a Healing: PCI to Spontaneous Coronary Artery Dissection Under Intravascular Ultrasound Guidance
Nay Thu Win1, Ahmad Farhan Abdul Hamid1, Hafidz Abd Hadi1
National Heart Institute, Malaysia1,
A 58 years old gentleman, who has no known medical illness, presented with recurrent central chest pain to a district hospital for one year. He was admitted twice for unstable angina. He is a chronic smoker but there is no history of drug abuse.
Electrocardiogram showed sinus rhythm, normal axis and T inversion at V1 and V2. Blood investigations showed normal renal function, liver function, total cholesterol level was 3.9 mmol/L and LDL was 1.9 mmol/L. Cardiac enzymes were normal.
Spontaneous coronary artery dissection in RCA presented with recurrent unstable angina. There was no-flow phenomenon to distal RCA because dissection segment was migrated until RPDA and RPL after predilatation. IVUS showed long dissection with intramural hematoma in RCA, RPDA and RPL. Stent in RCA was sealed the entry point of dissection and wait for one month to heal the distal dissection flap. Dissection in RPL was healed but there was persistent dissection in RPDA and RPL, which was stented successfully.