case_images: PMC8826099_01
case_images: ECG on admission. Slight ST segment elevation in the right precordial leads with reciprocal changes in the lateral wall of left ventricle.
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case_images: The electrocardiogram (ECG) on admission is shown in Figure 1.
case_images: Coronary angiography on admission: (a) RI dissection is indicated by a white arrow and (b) intact right coronary artery.
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case_images: ACS with ST segment elevation, the patient underwent coronary angiography. A linear dissection of ramus intermedius (RI) was established over 20 mm with stenosis of the lumen up to 80% in diameter against the background of thrombolysis in myocardial infarction (TIMI) 3 blood flow in all coronary arteries (Figure 2).
case_images: Stenting of RI: (a) the arrow indicates the inflated balloon at the dissection segment and (b) control angiogram after stenting of RI (stent is indicated by an arrow).
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case_images: TIMI 3 blood flow on control angiograms is shown in Figure 3.
case_images: ECG during the recurrence of chest pain. The ST segment elevation in the leads II, III, and aVF with reciprocal changes.
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case_images: ECG was performed (see Figure 4).
case_images: Repeated coronary angiography: (a) defect of contrasting of the RCA with stenosis by 90% (upper white arrow), occlusion of the distal segment (lower white arrow); (b) and (c) linear dissections of the RCA and the initial segment of the posterior lateral branch of the RCA (indicated by arrows).
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case_images: Dissection of the RCA after 15 min. Dissection is indicated by white arrows.
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case_images: According to the control angiography, after 15 min (see Figure 6), a decrease in the length of the dissected segment in the initial and middle sections of the RCA and posterior lateral branch of the RCA was established.
case_images: ECG from 14 May 2020.
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case_images: ECG was performed, and found that there were no significant dynamic changes from previous ECGs (see Figure 7).
case_images: Angiography from 14 May 2020. The stented segment of the RI is passed without contrast defects (upper white arrow); in one of the branches of RI stenosis with a length of 20-25 mm up to 85% in diameter (lower white arrow).
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case_images: The stented segment of the RI LCA was passable; however, in one of the RI branches, immediately after its bifurcation, stenosis of up to 85% in diameter with a length of 20-25 mm was detected, which was absent in the previous two angiograms (see Figure 8).
case_images: Chest computed tomography (17 May).
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case_images: CT of the chest in dynamics from April 2020 was also performed, which also showed no pathological changes (see Figure 9).