PSEUDO-STENOSIS BY VESSEL WALL INVAGINATI ON DURING INTERVENTIONAL THERAPY OF 2 CORONARY-ARTERIES IN ONE PATIENT

We report on a 59-year-old man who underwent a combined procedure of d irectional coronary atherectomy (DCA) and PTCA of significant lesions of the right coronary artery (RCA) and the left circumflex artery (LCX ). Already after positioning of a standard guide wire in the right cor onary artery a new excentric ''pseudo-stenosis'' was observed in the p roximal part of the right coronary artery. Since the patient remained symptom free, a 7F DCA catheter was introduced to the stenotic area in the mid RCA, which led to an extension of the narrowing, involving th e total segment proximal to the DCA catheter. Directional coronary ath erectomy was performed without complications. Removal of the catheter, after successful DCA, and administration of intracoronary nitroglycer in did not relieve the proximal narrowing, which disappeared spontaneo usly after the guide wire was pulled out. During PTCA of the left circ umflex using a standard guide wire and a 3.0 mm Monorail balloon cathe ter, a similar tight narrowing of the origin of the LCX was observed, which could also not be influenced by vasodilator drugs, but relieved after wire removal. Until now, this phenomenon has only been described for the right coronary artery. The reason underlying intimal folding is a shifting of the intimal layer against the medial layer of the ves sel wall. Our observation firstly describes this phenomenon of ''pseud o narrowing'' in two different vessels in one patient. We, like other authors before, recommend that interventional therapy of these pseudo- lesions should be avoided.