Author: Christian Loewe, Vienna, Austria
Body Region: Cardiovascular
Figure 1. Digital subtraction angiography (DSA) obtained during emergency coronary angiography. Several relevant coronary stenoses at the right coronary artery (RCA) (a) and the tortuous course of the guide wire and catheter due to the anatomical circumstances (kinking of the left subclavian artery, elongated aortic arch) can be observed. (b) The non-enhanced image clearly demonstrates contrast deposit within the aortic arch.
1. Patient presentation
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A 71-year-old man with a history of mitral valve repair was admitted because of acute chest pain.
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A typical ST elevation and high troponin-T levels led to a diagnosis of ST-elevation myocardial infarction (STEMI), so the patient underwent emergency coronary revascularization with a left radial artery approach due to anatomical circumstances.
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During the procedure, cannulation of the right coronary artery proved technically difficult due to stenosis (Fig. 1a). A iatrogenic aortic dissection was nonetheless recognized and an acute aortic syndrome was diagnosed (Fig. 1b) and successfully treated.
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Following treatment of the acute coronary syndrome, the patient still reported severe chest pain, so CT angiography was performed (Fig. 2).