PMC4773538_01
OCT image showing the guidewire in the false lumen as the true lumen is crushed against the vessel wall.
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We then decided to perform OCT (Terumo Lunawave  OFDI system) that clearly revealed the double-lumen morphology and also that the guidewire was in the false lumen (Figures 1 and 2).
OCT image showing two guidewires in the false lumen.
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We then decided to perform OCT (Terumo Lunawave  OFDI system) that clearly revealed the double-lumen morphology and also that the guidewire was in the false lumen (Figures 1 and 2).
OCT image showing one guidewire in the false lumen and the other in the true lumen.
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With live OCT images, without recording an actual pullback, we used small flushes of contrast until we were able to confirm that the guidewire was on the true lumen (Figures 3(a) and 3(b)).
OCT image showing the entry tear of the spontaneous dissection.
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OCT could also identify entry tear very clearly (Figure 4). Once the true lumen was secured, we proceeded to angioplasty with a drug-eluting stent sealing the entry tear in the proximal right coronary artery (Figure 5).
OCT performed after stent implantation showing good apposition.
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OCT could also identify entry tear very clearly (Figure 4). Once the true lumen was secured, we proceeded to angioplasty with a drug-eluting stent sealing the entry tear in the proximal right coronary artery (Figure 5).
OCT image showing the guidewire in the true lumen and the false lumen with signs of thrombosis in process.
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TIMI 3 flow, and the acute marginal branches were again visible, but there was a narrowing in the distal vessel where the false lumen was still visible but showing signs of thrombosis (Figure 6). To avoid making a full metal jacket, we decided to accept this result and perform a control angiography one month later.
OCT performed one month after the stent angioplasty, showing the maintenance of the dissection. (a) shows clearly that the guide wire is in the true lumen.
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Given the previous STEMI presentation and the negative angiographic evolution within a month, we carried out an OCT that confirmed the dissection and showed that the guidewire was now in the true lumen (Figures 7(a) and 7(b)).
OCT performed after implantation of additional stents in medial and distal RCA and the balloon after dilatation.
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In this setting, we decided to seal the dissection with implantation of two more drug-eluting stents in the mid and distal RCA to guarantee the long-term patency of the vessel (Figure 8).