Intravascular ultrasound-guided coronary stenting without contrast medium for the treatment of catheter-induced aortocoronary dissection

Catheter-induced aortocoronary dissection is a rare, but serious complication during diagnostic coronary catheterization or percutaneous coronary intervention (PCI). Immediate coronary artery stenting of the entry point is one of therapeutic options. However, PCI itself may worsen the dissection, because contrast injection has been reported to be a risk factor for the extension of dissected aorta. We present a case of 79-year-old male suffering from inferior acute myocardial infarction due to the catheter-induced aortocoronary dissection. Multi-slice computed tomography (MSCT) revealed an intramural hematoma of the ascending aorta and an intimal tear from the proximal portion of right coronary artery (RCA) to the intramural hematoma. We attempted intravascular ultrasound (IVUS)-guided coronary stenting without contrast injection. IVUS revealed that thrombus distributed from the ostium to middle portion of RCA. A 3.0 × 30 mm bare-metal stent was deployed to cover the distal end of thrombus, and a 3.5 × 30 mm bare-metal stent was deployed to cover the entry point and ostium of RCA. All procedures were done without contrast injection. Follow-up MSCT confirmed the patency of stents and the disappearance of the intimal tear. As contrast injection may cause the expansion of the dissected aorta, IVUS-guided stenting of the entry point without contrast injection can be a promising solution for such lesions.