PMC3485898_01
Angiographic projections (a) (35 LAO and 23 CRA):  dissection of the left anterior descending (LAD) artery, involving the origin and proximal tract of the first diagonal branch (FDB) (red arrows); (b) (9 RAO and 39 CRA): progression of the dissection to the distal tract of the LAD and in the FDB, and proximal occlusion of the left circumflex artery (LCX) (red arrow); (c) (25 RAO  and 23 CAU): angiographic result after POBA in the LCX; (d) (35 LAO  and 23 CRA): distal occlusion of the LAD (red arrow) and patency of the LCX in spite of the presence of a persistent line of dissection (violet arrow).
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fig1
The coronary angiogram, performed using the left radial approach, revealed a long dissection of the proximal and medium tract of the left anterior descending (LAD) artery, involving the origin and proximal tract of the first diagonal branch (FDB) (TIMI flow I) (Figure 1(a)). During the control angiogram, performed seven days later using a 4 French catheter, a progression of the dissection to the distal tract of the LAD and the FDB was shown and a proximal dissection with occlusion of the left circumflex artery (LCX) appeared (Figure 1(b)). Plain old balloon angioplasty (POBA) was immediately performed, obtaining TIMI flow III and symptoms resolution (Figure 1(c)). Despite an unchanged ECG and no enzyme rising, a third angiogram was carried out, showing distal occlusion of the LAD and LCX patency in spite of the presence of a persistent line of dissection (Figure 1(d)).
Final angiographic (35 LAO and 23 CRA) whereby normal patency of the coronary arteries is seen.
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PMC3485898_01_CRIM.VASMED2012-498465.002.jpg
fig2
The last control angiogram, performed 36 days after the admission, showed normal patency of all coronary arteries without any line of dissection (Figure 2).