Percutaneous coronary intervention (PCI) of a resistant, undilatable lesion can result in coronary dissection. Retrograde propagation of a dissection flap into the sinus of Valsalva is a rare phenomenon. It is commonly seen at the time of PCI to a right coronary artery (RCA) and is associated with potentially fatal consequences. Use of rotational atherectomy (RA) is contraindicated in the presence of a coronary dissection. Coronary dissection with preserved flow in asymptomatic patients should be managed conservatively until the dissection heals, but in the case presented here, as coronary flow was compromised, the patient complained of chest pain and ST elevation was observed on electrocardiogram.
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