Sequential Implantation of Triple Stents for Long Dissection Complicating Percutaneous Transluminal Coronary Angioplasty with Cutting Balloon: A case report

A 54-year-old female was admitted to our hospital because of unstable angina pectoris. There was a discrete and concentric 90% stenotic lesion at proximal RCA on coronary angiogram. PTCA was carried out on the lesion by means of a cutting balloon (Barath, IV T co'ltd) 3. 75 mm in diameter, and 15 mm long. During the first inflation, the balloon ruptured and the pressure of the indeflator decreased suddenly. Then the large dissection from proxymal to the distal segment of RCA was shown in the X-ray image and followed by acute occlusion. The first Palmaz-Schatz stent was implanted towards the entry of the dissection, but the long dissection could not be tacked up by only one stent and perfusion of the distal RCA was decreased. Then the second stent was implanted towards the distal end of the dissection, in order to prevent the distal progression of the dissection. The last stent was implanted in the mid -portion of the dissection, and post-dilation was performed after each stent implantation. Finally, successful emergency alleviation was obtained. There was no occurrence of subacute stent thrombosis. After the procedure, the cutting balloon was examined and a pin -hole rupture was found.