Distal coronary artery injury following successful percutaneous transluminal coronary angioplasty

A 65-year-old woman underwent successful percutaneous transluminal coronary angioplasty of a right coronary artery stenosis. Shortly thereafter, she developed chest discomfort and repeat angiography demonstrated a new area of stenosis distal to the area of original angioplasty. An attempt at a second angioplasty resulted in vessel occlusion with subsequent successful bypass surgery. The etiology of the new distal lesion is discussed.