Watanabe Yusuke, Sakakura Kenichi, Jinnouchi Hiroyuki, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
J Cardiol Cases. 2024 Dec 6;31(3):72-75. doi: 10.1016/j.jccase.2024.11.007. eCollection 2025 Mar.
Coronary artery dissection is a common complication in percutaneous coronary intervention (PCI). The bailout procedure from coronary artery dissection is relatively simple if a guidewire remains within the true lumen. However, if the guidewire migrates into a dissection cavity separated by a calcified plaque, the bailout procedure is more difficult even for experienced interventional cardiologists. In this case report, we provide a bailout procedure for complicated coronary artery dissection, in which the guidewire was pushed out from the true lumen to the false lumen behind calcified plaque. The knowledge of guidewire bias and intravascular ultrasound-guided PCI was useful and the technique to strengthen the back-up support was necessary for the successful bailout.
Guidewire migration into the false lumen behind a calcified plaque is a rare complication, but the knowledge of a bailout method using guidewire bias and intravascular ultrasound is important.
冠状动脉夹层是经皮冠状动脉介入治疗（PCI）中的常见并发症。如果导丝仍位于真腔内，冠状动脉夹层的补救操作相对简单。然而，如果导丝移入由钙化斑块分隔的夹层腔内，即使对于经验丰富的介入心脏病学家而言，补救操作也更加困难。在本病例报告中，我们提供了一种针对复杂冠状动脉夹层的补救操作方法，该夹层中导丝从真腔被推至钙化斑块后方的假腔内。了解导丝偏倚和血管内超声引导下的PCI操作很有用，加强支撑辅助技术对于成功补救是必要的。
导丝移入钙化斑块后方的假腔是一种罕见并发症，但了解使用导丝偏倚和血管内超声的补救方法很重要。
