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A 55-year-old man had undergone percutaneous coronary intervention for right coronary
artery (RCA) chronic total occlusion 2 years ago. The 3.0-mm balloon dilatation created
coronary dissection and an intramural haematoma (IMH). The intravascular ultrasound
revealed a no-reflow phenomenon with a large IMH extending to the distal RCA bifurcation.
A stent was implanted to cover the proximal dissection and IMH entry site. The distal
IMH was rescued by coronary fenestration with a 3.0-mm cutting balloon (Figure 1A). The TIMI-3 flow was regained with some residual dissection and IMH.
Figure 1Large false lumen flow persisted after intramural haematoma (IMH) fenestration with
a cutting balloon. A. Spiral coronary dissection and IMH after proximal inlet stenting
(arrow) and outlet cutting balloon fenestration (arrowhead). B. Persistent false lumen
flow (arrowhead, C2) from the previous IMH and drainage back to the cutting site (arrowhead,
C1). C1. The intravascular ultrasound showed extensive false lumen (∗) drainage to
the distal right coronary artery. C2. The false lumen (∗) was circulating outside
the stent structure.
