Ostial Circumflex Dissection Caused by Off-Track OCT Catheter

Achmad Fauzi Yahya, MD and Aninka Saboe, MD

Clinical Images

Ostial Circumflex Dissection Caused by Off-Track OCT Catheter

Achmad Fauzi Yahya, MD and Aninka Saboe, MD

November 2022

ISSN 1557-2501

Index J INVASIVE CARDIOL 2022;34(11):E822-E823. doi:10.25270/jic/22.00084

Keywords: cardiac imaging, complications, OCT catheter, ostial circumflex

Yahya OCT Catheter Figure 1 — Figure 1. Angiogram showed (A) moderate stenosis at the ostial left anterior descending artery and ostial left circumflex artery (LCX) (yellow arrow), stenosis at the distal LCX (white arrow) and (B) left main artery stenosis (*).

A 53-year-old man was planned for staged percutaneous coronary intervention (PCI) to the left circumflex artery (LCX). He had history of primary PCI at the proximal left anterior descending (LAD) 6 months earlier. Following coronary angiogram (Figure 1A, 1B), it was decided to perform an initial optical coherence tomography (OCT) evaluation. However, during delivery to the LAD, the OCT catheter was railed-off from the guidewire and knocked to the ostial LCX (Figure 2A and Video 1).

Yahya OCT Catheter Figure 2 — Figure 2. (A) Railed-off optical coherence tomography catheter, knocked proximal left circumflex artery. (B) Dissection at corresponding segments.

Yahya OCT Catheter Figure 3 — Figure 3. Optical coherence tomography run showed prior stent did not nail the ostial left anterior descending (LAD) and fibrotic plaque at the ostial LAD (minimum lumen area, 2.92 mm2). Eccentric left main stenosis was shown in 3, 4, 5 (yellow arrows). There was an intimal tear at the ostial left circumflex artery (red arrow).

Guide-catheter repositioning was performed to have a more coaxial engagement. Subsequently, the OCT catheter was successfully delivered to the distal LAD. The OCT study revealed stenosis with fibrotic plaque at the ostial LAD, eccentric lesion at the distal left main (LM), and intimal tear at the ostial LCX (Figure 3). During OCT evaluation, the patient was experiencing chest pain with unstable hemodynamics. Careful contrast injection revealed dissection at the ostial-proximal part of LCX with compromised antegrade flow (Figure 2B). We performed double-kissing culotte stenting at the left main bifurcation. The patient was then stabilized. The final angiogram and 3-dimensional OCT showed good results (Figure 4).

Yahya OCT Catheter Figure 4 — Figure 4. (A) Final angiogram and (B) 3-dimensional optical coherence tomography evaluation showed good results.

The purpose of these images is to make the readers aware of the genuine and serious risk of a “railed off” OCT catheter, especially while delivering the catheter at a bifurcation with an eccentric lesion. Meticulous OCT catheter delivery and improvement of the OCT catheter configuration may be considered to avoid this complication.

Affiliations and Disclosures

From the Department of Cardiology and Vascular Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 8, 2022.

Address for correspondence: Achmad Fauzi Yahya, MD, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Jawa Barat, Indonesia. Email: a.fauzi.yahya@unpad.ac.id

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Ostial Circumflex Dissection Caused by Off-Track OCT Catheter

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