Iatrogenic right coronary artery dissection distal to a total occlusion: a case report

INTRODUCTION: Coronary artery dissections with or without rupture is a rare but well-recognized complication of coronary angiography with a high morbidity and mortality rate. CASE PRESENTATION: 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.