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17 de mar. de 2021 · Distinct and clinically separate from spontaneous coronary artery dissection, CICAD is characterized by mechanical disruption of the endothelial cell layer of a coronary artery followed by extravasation of blood into subendothelial tissue planes.
IVUS may be used to assess the dissection, especially if the wire position—true lumen versus subintimal—is unclear. For large intramural hematomas, a cutting balloon may be considered to release the hematoma before stenting. 23 Long dissections may require initial stenting of the distal margin to prevent downstream propagation.
Abstract. Subintimal dissection/reentry techniques are increasingly being used for crossing coronary chronic total occlusions both antegradely (using a knucle wire or the Bridgepoint system) or retrogradely (using the controlled antegrade and retrograde tracking and dissection, and reverse controlled antegrade and retrograde tracking and ...
1 de mar. de 2021 · A true dissection will appear as a persistent intraluminal smooth flap or extraluminal linear or spiral extravasation of contrast media with or without diminished antegrade flow. In summary, CICAD is a rare but important complication of coronary angiography and PCI.
In this review we will (1) describe the CTO subintimal dissection/re-entry techniques and clarify the related terminology, (2) summarize published studies on this area, and (3) provide practical recommendations on how to implement these techniques and identify areas in need for further evaluation.
mechanisms, such as dissection (Figure 2. Panel G and H), intracoronary thrombus formation (Figure 2. Panel I), plaque/thrombus/air embolization (Figure 2. Panel I and K), no-reflow phenomenon, or. coronary spasm. Determining the cause of the acute closure is critical for providing optimal treatment.
Subintimal plaque modification is defined as balloon angioplasty of the subintimal space within the CTO body and occasionally beyond the distal cap of the CTO with a balloon sized 1:1 to the vessel diameter or greater than 2 mm in diameter to increase chances of TIMI 3 antegrade flow.
