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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 5  |  Issue : 3  |  Page : 215-216

Coronary Dissection or Pseudoaneurysm? An Ambiguity Resolved by Optical Coherence Tomography


Department of Cardiology, Apex Heart Institute, Ahmedabad, Gujarat, India

Date of Submission03-Sep-2019
Date of Decision24-Sep-2019
Date of Acceptance24-Sep-2019
Date of Web Publication20-Dec-2019

Correspondence Address:
Dr. Pradyot Tiwari
Apex Heart Institute, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_53_19

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  Abstract 


Coronary angiographic appearance of ambiguous-looking lesions can be deciphered by the use of optical coherence tomography. An apparent pseudoaneurysm on coronary angiography turned out to be a coronary dissection associated with aneurysm formation.

Keywords: Aneurysm, dissection, pseudoaneurysm


How to cite this article:
Tiwari P, Patel T, Shah S. Coronary Dissection or Pseudoaneurysm? An Ambiguity Resolved by Optical Coherence Tomography. J Pract Cardiovasc Sci 2019;5:215-6

How to cite this URL:
Tiwari P, Patel T, Shah S. Coronary Dissection or Pseudoaneurysm? An Ambiguity Resolved by Optical Coherence Tomography. J Pract Cardiovasc Sci [serial online] 2019 [cited 2020 Jan 25];5:215-6. Available from: http://www.j-pcs.org/text.asp?2019/5/3/215/273745



A 48-year-old male presented to us with recent anterior wall myocardial infarction. Coronary angiography revealed 90% tubular stenosis in the proximal left anterior descending (LAD) with an ambiguous saccular lesion just adjacent to it (outside the boundary of the lumen) and connected to it via a narrow neck [Figure 1]a. Coronary angiographic appearance led to a differential diagnosis of (1) coronary pseudoaneurysm (narrow neck of focal outpouching), (2) coronary dissection (? dissection flap), and (3) coronary aneurysm (focal outpouching but narrow neck against it).
Figure 1: (a) Coronary angiography showing a 90% stenosis in proximal left anterior descending with an ambiguous saccular lesion just adjacent to it with a narrow neck. (b) Optical coherence tomography image showing a dissection flap with aneurysm formation with intact three-layered wall.

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To characterize the disease, intravascular imaging with optical coherence tomography (OCT) was planned and revealed the culprit lesion as coronary dissection (dissection flap seen) with aneurysm formation (focal outpouching with intact three-layered wall) [Figure 1]b. Following delineation of the pathology of the lesion, LAD stenting followed to focal high-pressure postdilatation of the disease segment was undertaken. The importance of this case lies in the fact that intravascular imaging by OCT can help us differentiate these ambiguous-looking angiographic lesions and plan further management.

Teaching points:

  1. Ambiguous-looking lesions on coronary angiography should undergo intravascular OCT imaging to better delineate the lesion and plan further management
  2. Association of coronary dissection and pseudoaneurysm has been reported, but coronary aneurysm associated with dissection is rare and occurs in cases where dissection plane is intraintimal.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Ethics clearance

As per institute's guidelines, ethical clearance not required for case/image reports. However the authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his/her consent for his/her images and other clinical information to be reported in the journal. The patient understand that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




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