Aortocoronary dissection complicating percutaneous angioplasty.

A 56-year-old man was admitted to our hospital for elective coronary angioplasty of a chronic total occlusion (CTO) of the right coronary artery (RCA). After insertion of a right femoral sheath, the RCA was engaged with a 6 French Amplatz AL-2 (Cordis, Miami, Fl, USA) guiding catheter. Recanalization was begun using a 0.014-inch Miracle 3 guidewire (Asahi Intecc, Japan). At this stage, an ostial dissection flap of the RCA with immediate retrograde extension to the ascending aorta was noticed (Figure 1). Stenting of the RCA ostium with a Xience Prime 3.0 × 15 mm stent (Abbott Vascular, Santa Clara, California, USA) was performed, followed by a PTFE-covered 3.0 × 19 mm Jostent graft