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Contrast Injection Demonstrating Failed Dissection Re-entry Technique

03/28/2019

Video Supplement to “Dissection Re-entry Technique: How is it Really Looking?" [April 2019 Clinical Images article by Tsiafoutis, et al.]

A 65-year-old patient with a significant stenosis of the mid LAD coronary artery was referred for PCI with rotational atherectomy, after a failed initial PCI attempt in a peripheral hospital, in which this heavily calcified mid LAD lesion proved to be balloon-undilatable. The totally occluded lesion was approached with antegrade wire escalation; during the attempt, the vessel was dissected, and we therefore tried the subintimal tracking and re-entry technique, attempting wire-based re-entry to get into the true lumen. Unfortunately, this resulted in dissection enlargement and hematoma propagation in the distal vessel. Dissection re-entry is a widely used technique in many chronic total occlusion centers. This account of a failed re-entry attempt provides in vivo photographic evidence of how the vessel looked after such an attempt.


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