Coronary artery dissection secondary to selective coronary angiography.

Coronary artery dissection during coronary arteriography is a rare complication. We describe three cases occurred in our laboratory (0.18% of all the procedures). All the invasive procedures were performed with a femoral approach with Judkins catheters by three different surgeons with limited experience; all dissections involved the right coronary artery. Two patients were men with coronary artery disease and the third was a woman who underwent catheterization for mitral valve disease. An inferior acute myocardial infarction occurred in both men and one of them was surgically treated. No ischemia was observed in the female patient with mitral disease. According to previous reports, we believe that the patients at risk for such a complication (adults with diffuse coronary artery disease or young women with valvular disease and normal coronary arteries) must be more carefully considered. Moreover, in these patients soft-tip Judkins catheters should be used during femoral procedures in the right coronary artery.