After Deep-Seating…

-Case Report-

Zheng WU, MD Hongbing YAN, MD

Beijing Anzhen Hospital

Capital Medical University,Beijing,China

Case

Male, 44 yrs old

Paroxymal chest pain for 2 weeks

HBP, Smoke

CAD, UAP

mLAD 50%, LCX(-)

dRCA 90%

6FJR4.0 (deep-seating)

AVI2.5×10mm

It seems that

something is wrong?!

Endeavor2.5×14mm

long segment dissection in p-mRCA

Take one more look

Stop looking! Because…

The patient felt severe chest pain with

profuse sweating

BP 70/40mmHg and HR 40bpm

NS

infusion 、 dopamin 、 atropin 、 morphine

Endeavor3.5×30mm

Endeavor3.0×30mm,Endeavor3.5×24mm

Final Result

Causes of Secondary Dissection

Catheter (esp deep-seating) Amplatz 、 EBU 、 XB

Rather rare in Judkins

Guiding wire

Balloon

Stent

Contrast injection

Management

Maintain the hemodynamic stability Medical therapy IABP 、 ECMO CPR

Reperfusion as soon as possible PCI CABG

You can STOP procedure when Patient without/slight symptom Patient with stable hemodynamics

One case more

Male, 68years

Chest pain for 2hours

Smoke

ECG: II、 III、 avF ST↑0.2-

0.3mV

STEMI (inferior wall)

mRCA 90%

Zeek aspiration

Cypher 3.5×33mm,Cypher 3.5×33mm

Stents look good,it’s time to

end

OH NO!

Stents look good

however not everything

looks good

Post dilation with

NC Sprinter3.5×12mm

7 months later