1. After Deep-Seating… -Case Report- Zheng WU, MD Hongbing YAN, MD Beijing Anzhen Hospital Capital Medical University,Beijing,China

2. Case  Male, 44 yrs old  Paroxymal chest pain for 2 weeks  HBP, Smoke  CAD, UAP

3. mLAD 50%, LCX(-)

4. dRCA 90%

5. 6FJR4.0 (deep-seating) AVI2.5×10mm

6. It seems that something is wrong?!

7. Endeavor2.5×14mm long segment dissection in p-mRCA

8. Take one more look

9. Stop looking! Because…  The patient felt severe chest pain with profuse sweating  BP 70/40mmHg and HR 40bpm  NS infusion 、 dopamin 、 atropin 、 morphine

10. Endeavor3.5×30mm

11. Endeavor3.0×30mm,Endeavor3.5×24mm

12. Final Result

13. Causes of Secondary Dissection  Catheter (esp deep-seating)  Amplatz 、 EBU 、 XB  Rather rare in Judkins  Guiding wire  Balloon  Stent  Contrast injection

14. Management  Maintain the hemodynamic stability  Medical therapy  IABP 、 ECMO  CPR  Reperfusion as soon as possible  PCI  CABG  You can STOP procedure when  Patient without/slight symptom  Patient with stable hemodynamics

16. One case more  Male, 68years  Chest pain for 2hours  Smoke  ECG: II 、 III 、 avF ST↑0.2-0.3mV  STEMI (inferior wall)

17. mRCA 90%

18. Zeek aspiration

19. Cypher 3.5×33mm,Cypher 3.5×33mm

20. Stents look good,it’s time to end

21. OH NO!

22. Stents look good however not everything looks good

23. Post dilation with NC Sprinter3.5×12mm

24. 7 months later