A Double-wire Technique for Dealing with Catheter-induced Right Coronary Artery Dissection Extending to the Aortic Root

Abstract

Coronary artery dissection is a well-described complication of diagnostic angiography and has significant mortality and morbidity. The ideal management of acute coronary dissection and occlusion, whatever the cause, is prompt restoration of vessel patency to limit the duration and extent of ischemia. We report a 73-year-old man with simultaneous retrograde and antegrade spiral dissection of the right coronary artery caused by a guiding catheter during coronary angiography. We advised emergency bypass surgery for the patient, but his family refused. As an alternative to surgery, bail-out stenting of the dissected artery was done. We used a double-wire technique to advance a wire to the distal true lumen of the right coronary artery and placed intracoronary stents. This complication is very challenging for interventional cardiologists and the application of this technique may help increase the rate of success in its management.