PMC6336604_01
(A) An electrocardiogram recorded on the night of admission showed newly developed ST-segment elevation at leads II, III, and aVF. (B) Coronary angiography (RAO 30 , caudal 15 ) showed a double lumen in the middle portion of the left circumflex coronary artery (white arrow). (C) Intravascular ultrasound (IVUS) revealed a false lumen with a maximal diameter of nearly 7 mm. (D) IVUS with ChromaFlo mode revealed intima tearing with unobstructed flow between the true and false lumen (white arrow).
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F1
However, during the first night of hospitalization, she had a sudden onset of severe chest pain and a repeat ECG revealed ST segment elevation at leads II, III, and aVF (Fig. 1A). Coronary perforation with dye extravasation at the LCX was highly suspected according to CAG (Fig. 1B). Intravascular ultrasound (IVUS) showed a massive intramural hematoma with true lumen compression. ChromaFlo modality demonstrates colorized blood flow, which is helpful in detecting blood flow outside the vessel. The Chromaflo mode showed intimal perforation with continuous flow between the true and false lumen, and the maximal false lumen was approximately 6 to 7 mm (Fig. 1C and D).
After the deployment of a graft stent, the double lumen was no longer visible in the left circumflex (LCX) coronary artery. (A-C) Intravascular ultrasound images at a corresponding point of the LCX coronary artery in the angiogram (white arrow) showed adequate apposition of the stent.
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Park, IL) was deployed at the LCX. Post-stenting CAG and IVUS revealed minimal dye stasis in the peri-stent area and adequate apposition of the stent (Fig. 2A-C).
After 1 year of follow-up, coronary angiography showed in-stent restenosis located at stent proximal site. Intravascular imaging with (A) intravascular ultrasound and (B) optical coherence tomography showed the dissection flap with residual false lumen extended to proximal site of the left circumflex artery (C). After deployment of a drug-euling stent, the angiography showed totally resolution of the dissection flap (D) and optical coherence tomography showed the well apposition and expansion of the stent (E).
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The result showed in-stent restenosis at the proximal portion of the graft stent (Fig. 3A). IVUS revealed the residual hematoma located at the proximal site of stent (Fig. 3B). Optical coherence tomography (OCT) showed the dissection flap with residual false lumen at the proximal site of stent with a length of 8.9 mm extended to proximal portion of LCX (Fig. 3C). Followed OCT showed resolution of the dissection flap, well stent apposition, and stent expansion (Fig. 3D and E).