Author + information
- Received April 26, 2012
- Accepted May 12, 2012
- Published online October 1, 2012.
- Abelardo A. Martinez-Rumayor, MD,
- Subhash Banerjee, MD and
- Emmanouil S. Brilakis, MD, PhD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Emmanouil S. Brilakis, University of Texas Southwestern Medical Center, Dallas VA Medical Center (111A), VA North Texas Healthcare System, 4500 South Lancaster Road, Dallas, Texas 75216
A 73-year-old man presented with a non-ST-segment elevation myocardial infarction. Coronary angiography revealed severe lesions in the mid and proximal right coronary artery (RCA) (Fig. 1A). After pre-dilation, a dissection was noted at the mid RCA lesion (Fig. 1B). During attempts to deliver a 3.0 × 38-mm stent, guide and wire position were lost. Blood flow past the mid RCA lesion ceased, and the patient developed chest pain and ST-segment elevations. The dissected segment could not be rewired, despite the use of several guidewires (Fielder XT, Confianza Pro 12, Pilot 200, Abbott Vascular, Santa Clara, California) through a Finecross catheter (Terumo, Somersit, New Jersey) or through a Venture catheter (St. Jude, Minneapolis, Minnesota). We advanced the Pilot 200 guidewire (Abbott Vascular) to form a knuckle (Fig. 1C), which was advanced subintimally through the dissected lesion. A Stingray balloon and wire (Bridgepoint Medical, Minneapolis, Minnesota) were subsequently used to re-enter into the distal true lumen (Fig. 1D), as confirmed angiographically (Fig. 1E). With a Guideliner catheter (Fig. 1F) 3.0 × 38-mm and 3.5 × 23-mm stents were delivered and successfully deployed with an excellent final angiographic result (Fig. 1G). The patient had an uneventful recovery.
Subintimal dissection/re-entry crossing strategies are frequently used to facilitate crossing of chronic total occlusions (1,2). Our report demonstrates that the same techniques can be used to treat acute complications of percutaneous coronary interventions, such as crossing of a dissected coronary segment.
Dr. Banerjee has received Speaker honoraria from St. Jude Medical, Medtronic, Johnson and Johnson, Boehinger, Sanofi, and Mdcare Global and research support from Boston Scientific and The Medicines Company. Dr Brilakis has received Speaker honoraria from St. Jude Medical and Terumo and research support from Abbott Vascular; and his spouse is an employee of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2012.
- Accepted May 12, 2012.
- American College of Cardiology Foundation
- Brilakis E.S.,
- Grantham J.A.,
- Rinfret S.,
- et al.