PMC5643103_01
Baseline coronary angiography showed severe luminal stenosis of the mid left circumflex artery (head arrow).
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Coronary angiography revealed severe luminal stenosis of the mid left circumflex artery (Figure 1).
Angiography after stenting showed mild luminal narrowing with a dissection at the distal left circumflex artery (arrow).
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Although the final angiography showed residual mild luminal narrowing with a dissection at the distal LCX, there was no limitation of blood flow, so we concluded the procedure (Figure 2).
Emergent angiography revealed occlusion of the distal segment of the left circumflex artery (dotted arrow).
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Emergent angiography revealed occlusion of the distal segment of the LCX (Figure 3).
IVUS revealed progression of the intramural hematoma (H) and a totally compressed true lumen at the distal left circumflex artery. An intramural hematoma appears as a homogeneous, hyperechoic, crescent-shaped area.
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INTECC, Japan) into the distal LCX. Intravascular ultrasound (IVUS) revealed progression of intramural hematoma and a totally compressed true lumen at the distal LCX, a little apart from the distal edge of the stent (Figure 4).
A novel scoring balloon (arrow: NSE Alpha 2.5 x 13 mm, Goodman, Japan) was dilated in the far distal LCX.
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A novel scoring balloon (NSE Alpha 2.5 x 13 mm, Goodman, Japan) was dilated 5 times at 6 atmospheres in the far distal LCX (Figure 5).
IVUS after fenestration with a scoring balloon showed the resolution of the hyperechoic area within the hematoma space (*).
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IVUS images demonstrated the resolution of the hyperechoic area within the hematoma space; therefore, we considered a reentry to have been created (Figure 6).
Angiography after fenestration showed Thrombolysis in Myocardial Infarction 3 (TIMI-3) flow.
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Angiography showed TIMI-3 flow with a long dissection and the resolution of luminal narrowing (Figure 7).