



ORIGINAL ARTICLE Year : 2017 | Volume : 14 | Issue : 1 | Page : 31-34

Percutaneous intervention for Optitorque tiger catheter-induced dissection of the right coronary artery and aortic root



Sheshagiri Rao Damera, Ramachandra Barik, Akula Sivaprasad

Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India



Date of Web Publication 10-Mar-2017

Correspondence Address:

Ramachandra Barik

Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad - 500 082, Telangana

India

Source of Support: None, Conflict of Interest: None Check

DOI: 10.4103/0189-7969.201905



Abstract

A 59-year-old female developed iatrogenic Type F spiral dissection of the right coronary artery (RCA) with retrograde extension as Type III aortic dissection (AD) during diagnostic coronary angiogram using 5 Fr Optitorque Tiger catheter. The spiral dissection of RCA was treated with angioplasty. AD was followed up with conservative management. The prompt identification of the starting point, the true lumen, and exit point of the dissection is the keys to the successful percutaneous revascularization. Visual eyeballing into multiple angiographic views is of immense help in the situation where optical coherence tomography and intravenous ultrasound are not available.

Keywords: Angioplasty, aortic dissection, coronary artery, iatrogenic spiral dissection, Optitorque tiger diagnostic catheter

How to cite this article:

Damera SR, Barik R, Sivaprasad A. Percutaneous intervention for Optitorque tiger catheter-induced dissection of the right coronary artery and aortic root. Nig J Cardiol 2017;14:31-4

How to cite this URL:

Damera SR, Barik R, Sivaprasad A. Percutaneous intervention for Optitorque tiger catheter-induced dissection of the right coronary artery and aortic root. Nig J Cardiol [serial online] 2017 [cited 2020 Sep 17];14:31-4. Available from: http://www.nigjcardiol.org/text.asp?2017/14/1/31/201905

Introduction

Case Report

Figure 1: Diagtnostic angiograms showed (a) selective and deep hooking of the right coronary by Optitorque 5 Fr diagnostic catheter; (b) inadvertent pull back without controlled counter clock torque caused antegrade (coronary) and retrograde (the right aortic sinus) dissection; (c) the progress retrograde dissection into ascending aorta; (d) the profile of spiral dissection and it's distal end in the right anterior oblique view after a month; (e) the profile of spiral dissection in left lateral view after a month; (f) nonselective right coronary angiogram after a month showed healed linear dissection line near sinotubular junction



Click here to view

Figure 2: Angiographic views during angioplasty after a month showed (a) selective hooking of the right coronary artery using right Judkin's 6 Fr guide catheter showed spiral dissection the well-defined true lumen follows floor (green arrow) of the vessel; (b) the distal end of spiral dissection is followed in the right anterior oblique view showed with inner border (right-hand side of operator, marked by green arrow); (c) successful wiring of spiral dissection by the precision of unaided vision (no intravenous ultrasound or optical coherence tomography) and stenting; (d) the final result was TIMI III with adequate myocardial blush



Click here to view

Discussion

References

1.

Barber-Chamoux N, Souteyrand G, Combaret N, Ouedraogo E, Lusson JR, Motreff P. Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection. Cardiovasc Revasc Med 2016;17:138-42. 2. et al. Iatrogenic left main coronary artery dissection: Incidence, classification, management, and long-term follow-up. Am Heart J 2010;159:1147-53.

Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seiler C,Iatrogenic left main coronary artery dissection: Incidence, classification, management, and long-term follow-up. Am Heart J 2010;159:1147-53. 3.

López-Mínguez JR, Climent V, Yen-Ho S, González-Fernández R, Nogales-Asensio JM, Sánchez-Quintana D. Structural features of the sinus of Valsalva and the proximal portion of the coronary arteries: Their relevance to retrograde aortocoronary dissection. Rev Esp Cardiol 2006;59:696-702. 4.

Dunning DW, Kahn JK, Hawkins ET, O'Neill WW. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv 2000;51:387-93. 5. et al. Iatrogenic dissection of the ascending aorta following heart catheterisation: Incidence, management and outcome. EuroIntervention 2006;2:197-202.

Gómez-Moreno S, Sabaté M, Jiménez-Quevedo P, Vázquez P, Alfonso F, Angiolillo DJ,Iatrogenic dissection of the ascending aorta following heart catheterisation: Incidence, management and outcome. EuroIntervention 2006;2:197-202. 6.

Wyss CA, Steffel J, Lüscher TF. Isolated acute iatrogenic aortic dissection during percutaneous coronary intervention without involvement of the coronary arteries. J Invasive Cardiol 2008;20:380-2. 7.

Huber MS, Mooney JF, Madison J, Mooney MR. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol 1991;68:467-71. 8. et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005;129:112-22.

Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH,Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005;129:112-22. 9.

Tomassini F, Gagnor A, Varbella F. Perforation of the sinus of Valsalva by guiding catheter during the percutaneous coronary intervention via the right transradial approach: A very unusual complication. Catheter Cardiovasc Interv 2011;78:888-91. 10.

Awadalla H, Sabet S, El Sebaie A, Rosales O, Smalling R. Catheter-induced left main dissection incidence, predisposition and therapeutic strategies experience from two sides of the hemisphere. J Invasive Cardiol 2005;17:233-6. 11.

Dorros G, Cowley MJ, Simpson J. National Heart, Lung, and Blood Institute Registry report of complications of percutaneous transluminal coronary angioplasty. Am J Cardiol 1981;47:396. 12. et al. Aortic dissection as complication of percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1992;26:8-11.

Moles VP, Chappuis F, Simonet F, Urban P, De La Serna F, Pande AK,Aortic dissection as complication of percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1992;26:8-11. 13.

Pérez-Castellano N, García-Fernández MA, García EJ, Delcán JL. Dissection of the aortic sinus of Valsalva complicating coronary catheterization: Cause, mechanism, evolution, and management. Cathet Cardiovasc Diagn 1998;43:273-9. 14.

Maiello L, La Marchesina U, Presbitero P, Faletra F. Iatrogenic aortic dissection during coronary intervention. Ital Heart J 2003;4:419-22. 15.

Koga S, Ikeda S, Nakata T, Maemura K. Spontaneous spiral dissection of left internal thoracic artery graft. Int Heart J 2015;56:360-2. 16.

Suarez-Mier MP, Merino JL. False lumen stent placement during iatrogenic coronary dissection. Cardiovasc Pathol 2013;22:176-7. 17.

Sakakura K, Wada H, Taniguchi Y, Mori M, Momomura S, Ako J. Intravascular ultrasound-guided coronary stenting without contrast medium for the treatment of catheter-induced aortocoronary dissection. Cardiovasc Interv Ther 2013;28:71-5. 18.

Abdou SM, Wu CJ. Treatment of aortocoronary dissection complicating anomalous origin right coronary artery and chronic total intervention with intravascular ultrasound guided stenting. Catheter Cardiovasc Interv 2011;78:914-9. 19.

Abdou SM, Yip HK, Wu CJ. Transradial retrograde approach rescuing iatrogenic long spiral dissection during chronic total occlusion intervention. Catheter Cardiovasc Interv 2014;83:E159-64.