Successful treatment by percutaneous stent deployment of severe retrograde dissection of the right coronary artery extending into the sinus of Valsalva and ascending aorta.

Introduction. Dissection of the ostium of the right coronary artery (RCA) is a complication of PTCA which may become life-threating. Case report. A 45 year old man was admitted to our Coronary Care Unit (CCU) for acute anterior myocardial infarction. Coronary angiography revealed acute occlusion of left anterior descending coronary artery (LAD) and a chronic total occlusion of RCA. Primary PTCA of LAD was successfully performed. Nine days later he underwent PTCA of RCA; during the procedure the patient developed chest pain and ST-segment elevation in inferior leads. Angiography showed dissection of the RCA beginning at the ostium and progressing until the mid tract, which retrogradely extended into the sinus of Valsalva and ascending aorta. Two stents were placed at the entry door of the dissection, one at the ostium and one along the mid tract of RCA. Angiography showed successful sealing of the dissection. The ECG returned normal. Emergent transesophageal echocardiography and urgent CT scan confirmed the dissection resolved by stent apposition. Discussion. Management of the ostium dissection of the RCA involving the right sinus of valsalva depends on patients’ conditions, progression of aortic dissection and underlying coronary anatomy. In the case report here, dissection of RCA ivolving ascending aorta was successfully treated by stenting. Although surgical repair remains the best option, in the absence of complicating factors, percutaneous stent deployment may offer similar effective treatment.