Coronary artery dissection following angioplasty detected by multi-detector row computed tomography: Evaluation using the Plaque Map system

A 63-year-old woman was admitted to our hospital complaining with orthopnea. She had a history of myocardial infarction 1 year ago. Her ECG showed STelevation on leads II, III, and aVF, and q waves on left precordial leads. She was diagnosed as having acute inferior myocardial infarction and acute heart failure. Emergent coronary catheterization was performed. Coronary angiogram revealed an occlusion in the ostial portion of the right coronary artery without significant stenosis in the left coronary arteries. Insertion of the guide wire into the occluded right coronary artery was repeatedly performed, but the guide wire did not advance to the midportion of the right coronary artery. As a result, dissection with an intimal flap occurred in the right aortic cusp with no contrast opacification in the right coronary artery (Fig. 1A) and the interventional procedure was discontinued. After treatment for acute heart failure for a month, the second coronary angiography was performed. The distal portion of right coronary artery was contrast-enhanced through the pseudo-lumen (Fig. 1B, white arrow). For the further morphological assessment, 16-detector-row computed tomography (MDCT) was performed using a LightSpeed 16