PMC8826099_01
ECG on admission. Slight ST segment elevation in the right precordial leads with reciprocal changes in the lateral wall of left ventricle.
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The electrocardiogram (ECG) on admission is shown in Figure 1.
Coronary angiography on admission: (a) RI dissection is indicated by a white arrow and (b) intact right coronary artery.
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ACS with ST segment elevation, the patient underwent coronary angiography. A linear dissection of ramus intermedius (RI) was established over 20 mm with stenosis of the lumen up to 80% in diameter against the background of thrombolysis in myocardial infarction (TIMI) 3 blood flow in all coronary arteries (Figure 2).
Stenting of RI: (a) the arrow indicates the inflated balloon at the dissection segment and (b) control angiogram after stenting of RI (stent is indicated by an arrow).
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TIMI 3 blood flow on control angiograms is shown in Figure 3.
ECG during the recurrence of chest pain. The ST segment elevation in the leads II, III, and aVF with reciprocal changes.
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ECG was performed (see Figure 4).
Repeated coronary angiography: (a) defect of contrasting of the RCA with stenosis by 90% (upper white arrow), occlusion of the distal segment (lower white arrow); (b) and (c) linear dissections of the RCA and the initial segment of the posterior lateral branch of the RCA (indicated by arrows).
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Dissection of the RCA after 15 min. Dissection is indicated by white arrows.
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According to the control angiography, after 15 min (see Figure 6), a decrease in the length of the dissected segment in the initial and middle sections of the RCA and posterior lateral branch of the RCA was established.
ECG from 14 May 2020.
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ECG was performed, and found that there were no significant dynamic changes from previous ECGs (see Figure 7).
Angiography from 14 May 2020. The stented segment of the RI is passed without contrast defects (upper white arrow); in one of the branches of RI stenosis with a length of 20-25 mm up to 85% in diameter (lower white arrow).
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The stented segment of the RI LCA was passable; however, in one of the RI branches, immediately after its bifurcation, stenosis of up to 85% in diameter with a length of 20-25 mm was detected, which was absent in the previous two angiograms (see Figure 8).
Chest computed tomography (17 May).
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CT of the chest in dynamics from April 2020 was also performed, which also showed no pathological changes (see Figure 9).