[Collateral blood flow showing dissection-like filling defect on coronary arteriography: a case report].
A 51-year-old man presented under a diagnosis of angina pectoris manifesting as exertional chest pain. First coronary angiography showed severe stenosis with ulceration and spontaneous dissection at the proximal right coronary artery and linear dissection-like filling defects extending to the distal right coronary artery. After about 3 months, repeat coronary angiography showed the previously observed stenosis with unclear dissection, and better developed collaterals from the left coronary artery to the right coronary artery showing the linear dissection-like filling defects. The bilateral coronary angiography did not clearly show filling defects. This phenomenon suggested that the collateral flows were related to filling of the defects. Intravascular ultrasonic imaging demonstrated severe atherosclerotic lesions at the proximal right coronary artery, but no dissection in the distal right coronary artery. Percutaneous transluminal coronary angioplasty for the stenosis was performed successfully with a stent. Coronary angiography after the angioplasty showed no collaterals, and the right ventricular branch appeared, suggesting that the linear dissection-like filling defects extending to the distal right coronary artery were due to the collateral flows. Filling defects extending distal to a severe stenosis must be distinguished carefully from coronary dissection.
Fukuoka
Y
Y
Second Department of Internal Medicine, Faculty of Medicine, University of Kagoshima, Sakuragaoka 8-35-1, Kagoshima, Kagoshima 890-8520.
Sonoda
M
M
Terashi
T
T
Kawabata
K
K
Sannou
K
K
Uenomachi
H
H
Tanaka
Y
Y
Arima
T
T
D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography