PMC6524419_01
Angiography of the left coronary artery demonstrating the original stenosis in the mid-left circumflex artery (arrow)
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F1
His coronary angiogram showed 90% mid-LCX stenosis and 100% mid-right coronary artery (RCA) chronic total occlusion with collaterals from proximal RCA supplying the distal RCA and collaterals from the distal left anterior descending artery (LAD) supplying the right posterior descending artery [Figure 1].
Angiography of the left coronary artery demonstrating successful stent implantation in the mid-left circumflex artery (arrow)
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F2
The mid-LCX was directly stented successfully with 3.5 mm x 12 mm drug-eluting stent (DES) [Figure 2] and then postdilated with noncompliant balloon at a pressure of 12 atm for 20 s.
Relook angiography of the left coronary artery showing a new long and hazy luminal narrowing just distal to the stent (arrow)
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F3
It showed new 80% long and hazy stenosis with TIMI flow 3 at the proximal obtuse marginal artery (OM2) extending from the distal end of the LCX stent which was deployed a day before [Figure 3].
(a) Optical coherence tomography of the left circumflex artery showing edge dissection distal to the stent. (b) Optical coherence tomography of the left circumflex artery showing intramural hematoma secondary to edge dissection distal to the stent
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F4
OCT showed edge dissection at the distal end of the stent that created a big intramural hematoma compressing the true lumen of the LCX [Figure 4].
Relook angiography of the left coronary artery showed successful stent implantation in the proximal obtuse marginal artery (arrow)
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F5
Direct stenting was performed in the proximal OM2 using DES (Xience PRO x 3.0 mm x 23 mm) overlapped with previous stent in the mid-LCX covering the edge dissection [Figure 5].
Poststenting optical coherence tomography of the left circumflex artery showing complete resolution of intramural hematoma and edge dissection, with well-apposed stent
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F6
Poststenting OCT showed complete resolution of the intramural hematoma and edge dissection, with well-apposed stents [Figure 6].