Intravascular ultrasound-guided bail-out therapy in a case of acute myocardial infarction with iatrogenic coronary artery spiral dissection.

A 54-year-old man with suspected vasospastic angina returned to the hospital 2 weeks later with symptoms of acute myocardial infarction. Emergent coronary angiography (CAG) showed an occlusive lesion just beyond the bend of the proximal right coronary artery segment. The selected 7F AL1.0 guiding catheter may have injured the vessel surface and the guide wire might have entered the pseudo-lumen. Balloon dilatation of the pseudo-lumen resulted in a spiral dissection. We were able to provide bail out with therapy under guidance of combined CAG and intravascular ultrasound, which provided structural 3D images of coronary artery anatomy. <Learning objective: It is essential for percutaneous coronary intervention operators to understand the combination CAG and intravascular ultrasound, which provides structural 3D images of coronary artery anatomy, even though the target lesions would not be so complicated as chronic total occlusion.>.