IVUS-guided TD-ADR successfully enabled true lumen re-entry and LAD revascularization after severe coronary dissection, leading to hemodynamic stabilization and recovery.
Does IVUS-guided TD-ADR enable successful true lumen re-entry and revascularization in a patient with severe coronary artery dissection during PCI?
IVUS-guided TD-ADR is a feasible and effective bailout technique for severe coronary dissection during complex PCI, enabling accurate true lumen re-entry and timely revascularization.
Absolute Event Rate: 0% vs 0%
Abstract Background Coronary artery dissection during percutaneous coronary intervention (PCI) may lead to hemodynamic collapse. Intravascular ultrasound (IVUS)-guided tip detection–antegrade dissection re-entry (TD-ADR) may serve as a bailout strategy. We describe a unique case in which IVUS-guided TD-ADR successfully achieved true lumen re-entry after severe coronary dissection. Case summary A 64-year-old woman who had received long-term immunosuppressive therapy for rheumatoid arthritis was admitted for unstable angina. Subsequent evaluation revealed severe multivessel disease, and the patient underwent PCI of the left anterior descending artery (LAD). During the procedure, the patient experienced cardiac arrest, likely due to worsening global myocardial ischemia, and required venoarterial extracorporeal membrane oxygenation support. IVUS demonstrated subintimal wire tracking with true lumen collapse. IVUS-guided TD-ADR using a high-penetration chronic total occlusion wire supported by a microcatheter enabled precise re-entry into the true lumen and successful LAD revascularization. Severe left circumflex artery stenoses were also considered to perpetuate myocardial ischemia and hemodynamic instability, necessitating rescue PCI for hemodynamic stabilization. In addition, major bleeding complications due to guidewire-induced perforation of the right subclavian artery branch were managed using stenting and coil embolization. The patient recovered left ventricular function and was discharged in stable condition. During the 8-month follow-up after discharge, the patient was free of adverse events. Discussion This case highlights the feasibility of IVUS-guided TD-ADR as a bailout technique for coronary dissection during complex PCI. By enabling accurate true lumen re-entry, this approach facilitates timely revascularization and contributes to hemodynamic stabilization and recovery in a life-threatening setting.
Izumoto et al. (Thu,) reported a other. IVUS-guided TD-ADR successfully enabled true lumen re-entry and LAD revascularization after severe coronary dissection, leading to hemodynamic stabilization and recovery.