|Year : 2019 | Volume
| Issue : 3 | Page : 215-216
Coronary Dissection or Pseudoaneurysm? An Ambiguity Resolved by Optical Coherence Tomography
Pradyot Tiwari, Tejas Patel, Sanjay Shah
Department of Cardiology, Apex Heart Institute, Ahmedabad, Gujarat, India
|Date of Submission||03-Sep-2019|
|Date of Decision||24-Sep-2019|
|Date of Acceptance||24-Sep-2019|
|Date of Web Publication||20-Dec-2019|
Dr. Pradyot Tiwari
Apex Heart Institute, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
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.
- Ambiguous-looking lesions on coronary angiography should undergo intravascular OCT imaging to better delineate the lesion and plan further management
- 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.
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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.
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
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Conflicts of interest
There are no conflicts of interest.