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(Circulation. 1999;99:E17.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Intracoronary Ultrasound Longitudinal Reconstruction of a Postangioplasty Coronary Artery Dissection

I. Patrick Kay, MBChB; Manel Sabate, MD; Jurgen M. R. Ligthart, BSc; Willem J. van der Giessen, MD, PhD; Pim J. de Feyter, MD, PhD; Patrick W. Serruys, MD, PhD

From the Thoraxcenter, Academisch Ziekenhuis Rotterdam, Netherlands.

Correspondence to I.P. Kay, Department of Interventional Cardiology, Thoraxcenter, Academisch Ziekenhuis Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.

	Introduction

 
A62-year-old woman presented with unstable angina. Angiography demonstrated a severe stenosis in the distal right coronary artery (RCA), and angioplasty with stent implantation was undertaken. This was complicated by a coronary artery dissection distal to the stent that was detected by angiography and intracoronary ultrasound (ICUS).

View larger version (148K): [in this window] [in a new window]   Figure 1. Coronary angiogram (left anterior oblique projection) demonstrates a longitudinal dissection proximal to bifurcation of right coronary artery into posterior descending and posterolateral arteries. Inset, ICUS catheter is in posterolateral branch; contrast staining is present inferior to artery (arrow). ICUS was performed at this site with a 30-MHz transducer mounted on a 2.9F catheter (Microview, Boston Scientific-CVIS).

View larger version (81K): [in this window] [in a new window]   Figure 2. Longitudinal reconstruction of dissection: letters A through C correspond to ICUS transverse sections of accompanying images. In following images, proximal vessel is denoted by a, where both normal and slow blood flow are seen in a double-barreled lumen; b corresponds to transverse section, where blood/contrast interface is seen; and a' denotes area where only contrast within false lumen is seen. Note that artery bifurcates, with ICUS catheter present in posterolateral vessel. Distal dissection stops short of posterior descending artery.

View larger version (179K): [in this window] [in a new window]   Figure 3. Classic double-barreled lumen is seen, with a flap denoted by arrow. Lumen (b) has normal blood flow, whereas flow in a is decreased.

View larger version (202K): [in this window] [in a new window]   Figure 4. As false lumen fills with blood, a blood/contrast level is demonstrated (a').

View larger version (198K): [in this window] [in a new window]   Figure 5. A subintimal dissection with an echolucent contrast–filled false lumen (a) is seen. Arrows denote cardiac veins and are not associated with dissection. Because there . . . [Full Text of this Article]

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