Salamone Ignazio, Carerj Maria Ludovica, Barbaro Ugo, Virga Vittorio, Zito Concetta, Bracco Antonio, Blandino Alfredo, Racchiusa Sergio
Departments of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino," Messina, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Policlinico "G. Martino," Messina, Italy.
J Cardiovasc Echogr. 2019 Apr-Jun;29(2):62-64. doi: 10.4103/jcecho.jcecho_13_19.
We report a rare case of iatrogenic right coronary artery (RCA) dissection complicated by a retrograde subtle aortic dissection, which occurred during a primary percutaneous transluminal coronary angioplasty (PTCA). A 65-year-old female, with acute anterior ST-elevation myocardial infarction (STEMI), promptly underwent primary PTCA in the left anterior descending artery. After 5 h, the patient's condition becomes worse with recurrence of chest pain and new electrocardiogram modifications suggestive of inferior STEMI. A second coronary angiography revealed a spiral dissection extending from the ostium to the medium tract of the RCA. At the same time, a contrast media extravasation due to coronary ostium fissure occurred. Coronary stents were implanted from the medium tract of the right coronary to the ostium, to promptly arrest the active bleeding and to treat the dissection. After cardiosurgical advice, the patient was referred to the radiology department, where she underwent computed tomography angiography (CTA), which showed a small hematoma in the anterior wall of the ascending aorta. The stable clinical conditions of the patient suggested a conservative therapeutic approach. During the following 6 weeks CTA and transesophageal echocardiography were performed to rule out any other complication, and the patient was fortunately discharged with almost complete resolution of the hematoma.
我们报告了一例罕见的医源性右冠状动脉（RCA）夹层并发逆行性轻微主动脉夹层病例，该病例发生在初次经皮冠状动脉腔内血管成形术（PTCA）期间。一名65岁女性，患有急性前壁ST段抬高型心肌梗死（STEMI），迅速接受了左前降支的初次PTCA。5小时后，患者病情恶化，胸痛复发且出现新的心电图改变，提示下壁STEMI。第二次冠状动脉造影显示螺旋状夹层从RCA开口延伸至中段。同时，由于冠状动脉开口破裂出现造影剂外渗。从右冠状动脉中段至开口植入冠状动脉支架，以迅速止住活动性出血并治疗夹层。经心脏外科会诊后，患者被转至放射科，在那里接受了计算机断层血管造影（CTA）检查，结果显示升主动脉前壁有一个小血肿。患者稳定的临床状况提示采取保守治疗方法。在接下来的6周内，进行了CTA和经食管超声心动图检查以排除任何其他并发症，幸运的是患者出院时血肿几乎完全消退。
