Rescue of Iatrogenic Spiral Dissections Using an Intravascular Ultrasound-Guided Parallel Wire Technique

Percutaneous coronary intervention carries a risk of iatrogenic catheter dissection. A spiral aorto-ostial dissection can completely occlude the vessel and cause ischemia with significant hemodynamic compromise. The mortality from such dissections is approximately 6.5%. The situation can be rescued percutaneously by stenting the true lumen open, but this relies on having a wire within the true lumen. Large dissections often have a small true lumen that is hard to wire and a large false lumen that wires easily. There is a paucity of literature outlining the necessary steps to achieve procedural success. This case series includes 2 spiral dissections and demonstrates a step-by-step approach to manage this situation successfully.