02 Jan 2024
It’s (never) just a quick, diagnostic cath…
#CardioTwitterCase originally published on Twitter
Step-by-step video on how to successfully manage a universal radial diagnostic catheter induced coronary dissection.
This case was originally published on Twitter by @baijazvascular
Clinical presentation
A 73-year-old female patient underwent diagnostic angiography for chest pain, frequent premature ventricular contractions, and an abnormal nuclear stress test showing inferior ischemia, despite medical treatment.
A diagnostic universal radial catheter (Jacky - Terumo Interventional) was used to engage the right coronary artery (RCA). Initial RCA angiography showed extensive dissection initiating in the proximal RCA, propagating rapidly down the vessel (Video 1).
Patient reported chest pain, with ST elevation seen on ECG tracing. Immediate restoration of flow was planned.
Case description
A JR-4 guide catheter was brought to the ostium of RCA, followed by engagement of RCA with a work-horse wire (Run Through – Terumo Interventional). This kept buckling in a dissection plane/sub-intimal space. A hydrophilic wire (Pilot 50 – Abbott Cardiovascular) was advanced in parallel, though it remained sub-intimal.
A 3.0 mm x 12 mm compliance balloon was advanced over the Run Through wire to the tip, and used to fenestrate the dissection flap, followed by immediate advancement of the hydrophilic wire. True lumen was achieved and the wire was successfully advanced to distal vessel.
IVUS was used to confirm wire position, followed by placement of 3 overlapping drug eluting stents (3.5 x 38 mm, 4.0 x 38 mm and 4.0 x 38 mm) starting at distal normal vessel, all the way to ostium of the RCA followed by post dilation with 4.5 mm non-compliant balloon (Video 2).
Final angiography showed complete sealing of dissection with TIMI 3 flow in the vessel (Video 3), with concurrent resolution of patients symptoms and ECG changes.
Videos:
Final remarks
Diagnostic catheter induced coronary dissection is a rare, potentially catastrophic complication. Attempt at rapid restoration of flow in the cardiac catheterization lab should be undertaken.
Original tweet and Twitter discussion
There is no "it'll be a quick diagnostic"/"just a left heart cath"/"ill just shoot the cors". For all trainees, and early careers: Always have an appropriate indication, documentation, discussion and some reservation. Please add additional wisdom.. pic.twitter.com/hSYYCKlFw4
— Bilal Aijaz (@baijazvascular) September 25, 2023
1 comment
Brilhant!! Never a quick angiogram!!