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A 68 year-old male with hypertension, dyslipidemia, and current smoking as coronary risk factors was referred for coronary angiography (CAG) in lieu of chronic stable angina. He was Canadian Cardiovascular Society class III despite guideline-directed medical treatment. The CAG revealed a critical stenotic lesion (90%) in the proximal left circumflex (LCx) coronary artery with mild calcification. A 3.5 × 23 mm Xience prime drug-eluting stent (Abbott Vascular, USA) was deployed at 8 atm. Duringthe procedure, he developed chest pain. Angiogram revealed a long spiral dissection starting from the distal edge of the stent. To bail out, another overlapping 3 × 38 mm Xience prime stentwas deployed at 10 atm pressure, showing proper stent expansion and no residual dissection flap with TIMI-3 coronary flow. This case highlights that dissection can occur in a calcified vessel even below the nominal pressure which could be successfully bailed out by implantation with another coronary stent with complete cover of the coronary dissection.

Can nominal burst pressure guarantee against dissection during percutaneous transluminal coronary angioplasty?