Acute dissection of the RCA status post angioplasty with inferior wall infarction.

Answer

Diagnosis: Acute dissection of the RCA status post angioplasty with inferior wall infarction.

Images: The contrast enhanced CT images demonstrate an acute dissection of the proximal right coronary artery evidenced by short segment filling defect and occlusion at its origin.

 

The post gadolinium MR images show abnormal, near transmural myocardial enhancement along the inferior wall. This is in the RCA territory and consistent with infarction.

 

Discussion: Coronary artery dissection is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI), occurring in less than 1% of cases. These may be induced by angioplasty or guide wire puncture.

 

They are classified as Type A to Type F, described in detail in the reference article listed below. In general, Type A and B are benign and may be managed clinically. The remaining types may be life-threatening.

 

Spontaneous dissection can also occur but is extremely rare. It is usually found in young women, often in the peripartum period. The LAD is most commonly affected. Trauma and cocaine use are other potential causes.

 

The most common complication is ischemia/infarction of the corresponding myocardial territory. Death can occur without treatment, typically with stenting or coronary bypass grafting (CABG) if necessary.

 

Reference:

1. Rogers, JH Coronary Artery Dissection and Perforation Complicating Percutaneous Coronary Intervention. Journal of Invasive Cardiology, Vol 16 Issue 9, September 2004

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