A case of spiral dissection during diagnostic coronary angiography / 대한내과학회지

ABSTRACT

Severe, occlusive spiral dissection during diagnostic coronary angiogram is very rare. A 41-year old female patient was admitted because of chest pain at night. Her left coronary angiogram revealed no significant stenosis with diffuse luminal narrowing. Immediately after right coronary artery (RCA) injection, sudden occlusion of middle RCA was noted, which was not improved despite multiple injections of intracoronary nitrate. The patient complained of severe chest pain and ST segment elevation was observed on electrocardiogram monitoring. After wiring into true lumen of RCA, distal flow was improved and intravascular ultrasound revealed spiral dissection flap extending from proximal to middle RCA. Final coronary angioram showed patent RCA with spiral dissection and good distal flow into the distal RCA. The patient had no clinical events during 2-month clinical follow-up.