The 60 -year- old female patient. She was hospitalized with persistent chest pain on exertion. She did the EST Treadmill in Singapore, which is unusual. She was advised to consult a cardiologist for further evaluation. She came to our hospital to continue her treatment as planned
HR: 75 bpm
BP: 125/70 mmHg.
She was still on and off chest discomfort during normal activities. She was indicated for coronary angiogram
Echo: EF 70%. No RWMA.
Coronary angiography with significant RCA lesion CAG- LCX-Caud.avi CAG- LCx.avi CAG- RCA.avi
According to the classification of aortic dissection in coronary intervention.
We have consider: put cover-stent in ostial RCA ?
call surgery team to activate OT ? or watch and wait ?
This is dissection of the retrograde aorta, we continued to stenting right coronary. Explain to patient’s family regarding interventional event. She should be follow in ICU; •proceed controlled BP <120/80 mmHg and HR around 60 bpm.
We have daily ICU monitoring by echocardiography and MSCT aorta was done which no issue result, maintained DAPT (Clopidogrel and ASA) . After that, she was discharged from the hospital in stable condition. rca15.avi rca17.avi rca10.avi
- Acute aortic dissection during PCI remains a very rare complication, with an overall incidence of 0.02%
- Retrograde spread of a coronary artery dissection due to mechanical trauma by instruments used such as a guide catheter, wire, inflated balloon, etc. And calcified aorta has also been suggested to be a risk factor for this complication
- GradeI and II patients with limited involvement of the aorta can benefit from stenting of the coronary dissection without surgical intervention