A 66-year-old female who presented with unstable angina.
She had previous PCI with DES from the ostial todistal the RCA, and LAD due to iatrogenic spiral dissection during angioplasty.
However, recent coronary angiography revealed medial LAD in-stent chronic total occlusion (CTO), ostial and medial Cx with 90% stenosis (Fig. 1a).
We treated the Cx with a drug-coated balloon (DCB)(Selution).
A small new dissection medial Cx occurred. We decided to manage it conservatively as the patient was asymptomatic with TIMI flow lII (Fig. 1b).
8 hours later, the patient developed lateral wall ST segment elevation myocardial infarction.
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Coronary angiography: revealed Cx with iatrogenic antegrade and retrograde propagation flow limiting dissection(Fig.1c).
After dissection modification with cuttering technique, we performedIVUS-guided ostial to medial Cx-PCI (3.0x 24 mm, Synergy, Boston Scientific, Marlborough, USA) and medial to distal Cx with Freesolve BRS(Biotronik, berlin, Germany) (Fig. 1d)
The decision to off-label implantation of BRS distal Cx was taken to avoid mid-term instent occlusion in a distal small diameter Cx. The 3-month follow-up was uneventful.
