title: Iatrogenic right coronary artery dissection distal to a total occlusion: a case report.
abstract: BACKGROUND
  Coronary artery dissections with or without rupture is a rare but well-recognized complication of coronary angiography with a high morbidity and mortality rate.
  
  
  METHODS
  We present a rare case of right coronary artery dissection distal to a totally occluded vessel. The vessel dissected during the second injection of contrast agent without any direct mechanical manipulation (catheter or guide-wire induced). Hopefully the dissection had no clinical consequences and the patient was discharged after 48 hour intensive monitoring.
  
  
  CONCLUSIONS
  We believe that the contrast agent that was forced in the proximal part of the RCA increased through the anastomotic branches the sheer stress on the diseased endothelium of the distal artery causing it to dissect. It is an instructive -not previously described- phenomenon that underscores that atherosclerotic tissue is unpredictable and should be treated with extreme caution.
authors.affiliation: Department of Cardiology, Army Veterans Hospital Athens Greece. cardiologiki@nimts.gr
authors.forename: Demetrios
authors.initials: D
authors.lastname: Antoniades
authors.forename: Stavros
authors.initials: S
authors.lastname: Apostolakis
authors.forename: Spiros
authors.initials: S
authors.lastname: Tzoras
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Lazaridis