Case report: coronary artery dissection complicating stent implantation and percutaneous coronary intervention with hematoma in the distal right coronary artery

Coronary artery angiography (CAG)/ percutaneous coronary intervention (PCI) and stent placement for restenosis is an important means of diagnosis and treatment of coronary heart disease. The case presents a 61-year-old woman with coronary artery disease who presented with recurrent wheezing, chest tightness, palpitations, and a sensation of pharyngeal blockage. A recent coronary artery computed tomography angiography (CTA) indicated CAD-RADS grade 4 coronary atherosclerosis, characterized by calcified plaques and varying degrees of stenosis in the left main trunk, left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). The patient exhibited intermittent T-wave changes on a dynamic electrocardiogram, leading to her admission for treatment and complete coronary angiography. The angiography revealed significant stenosis in the LAD, diffuse plaque lesions in the LCX, and dissection from the middle to distal RCA, confirming spontaneous coronary artery dissection (SCAD). The patient underwent a two-stent procedure, which resulted in favorable outcomes with TIMI flow grade 3 observed in the RCA. Additionally, balloon angioplasty, stenting, multi-catheter angiography, and percutaneous coronary intervention (PCI) were performed to address proximal-mid RCA dissection with intramural hematoma. The case study concludes by highlighting the successful management of severe RCA stenosis, dissection, and hematoma using a PCI strategy for SCAD.