Successful Tip Detection-Antegrade Dissection and Re-Entry for Chronic Iatrogenic Coronary Artery Dissection Using a 6Fr Guiding Catheter: A Technical Challenge Overcome.

A 57-year-old man presented with recurrent exertional angina 1 month after an unsuccessful PCI attempt elsewhere. Angiography revealed severe stenosis and a chronic dissection of the posterior lateral artery (PLA). PCI was performed via a 6 Fr right transradial guiding catheter. Initial intravascular ultrasound (IVUS) using OptiCross HD (Boston Scientific; 3.1 Fr outer diameter [OD], 20 mm transducer-to-tip distance [TTD]) confirmed guidewire placement in the subintimal space within the extensive chronic dissection. TD-ADR was successfully performed using the OptiCross HD IVUS and a low-profile Carnelian MARVEL microcatheter (1.9 Fr OD), both accommodated within the 6 Fr guide. True lumen re-entry was achieved, followed by balloon dilatation, side branch management, and successful drug-eluting stent deployment in the main vessel, confirmed by final angiography and IVUS.