case_images: PMC5643103_01
case_images: Baseline coronary angiography showed severe luminal stenosis of the mid left circumflex artery (head arrow).
case_images: CRIC2017-8189530.001.jpg
case_images: PMC5643103_01_CRIC2017-8189530.001.jpg
case_images: fig1
case_images: Coronary angiography revealed severe luminal stenosis of the mid left circumflex artery (Figure 1).
case_images: Angiography after stenting showed mild luminal narrowing with a dissection at the distal left circumflex artery (arrow).
case_images: CRIC2017-8189530.002.jpg
case_images: PMC5643103_01_CRIC2017-8189530.002.jpg
case_images: fig2
case_images: Although the final angiography showed residual mild luminal narrowing with a dissection at the distal LCX, there was no limitation of blood flow, so we concluded the procedure (Figure 2).
case_images: Emergent angiography revealed occlusion of the distal segment of the left circumflex artery (dotted arrow).
case_images: CRIC2017-8189530.003.jpg
case_images: PMC5643103_01_CRIC2017-8189530.003.jpg
case_images: fig3
case_images: Emergent angiography revealed occlusion of the distal segment of the LCX (Figure 3).
case_images: IVUS revealed progression of the intramural hematoma (H) and a totally compressed true lumen at the distal left circumflex artery. An intramural hematoma appears as a homogeneous, hyperechoic, crescent-shaped area.
case_images: CRIC2017-8189530.004.jpg
case_images: PMC5643103_01_CRIC2017-8189530.004.jpg
case_images: fig4
case_images: INTECC, Japan) into the distal LCX. Intravascular ultrasound (IVUS) revealed progression of intramural hematoma and a totally compressed true lumen at the distal LCX, a little apart from the distal edge of the stent (Figure 4).
case_images: A novel scoring balloon (arrow: NSE Alpha 2.5 x 13 mm, Goodman, Japan) was dilated in the far distal LCX.
case_images: CRIC2017-8189530.005.jpg
case_images: PMC5643103_01_CRIC2017-8189530.005.jpg
case_images: fig5
case_images: A novel scoring balloon (NSE Alpha 2.5 x 13 mm, Goodman, Japan) was dilated 5 times at 6 atmospheres in the far distal LCX (Figure 5).
case_images: IVUS after fenestration with a scoring balloon showed the resolution of the hyperechoic area within the hematoma space (*).
case_images: CRIC2017-8189530.006.jpg
case_images: PMC5643103_01_CRIC2017-8189530.006.jpg
case_images: fig6
case_images: IVUS images demonstrated the resolution of the hyperechoic area within the hematoma space; therefore, we considered a reentry to have been created (Figure 6).
case_images: Angiography after fenestration showed Thrombolysis in Myocardial Infarction 3 (TIMI-3) flow.
case_images: CRIC2017-8189530.007.jpg
case_images: PMC5643103_01_CRIC2017-8189530.007.jpg
case_images: fig7
case_images: Angiography showed TIMI-3 flow with a long dissection and the resolution of luminal narrowing (Figure 7).