Left main coronary artery dissection during percutaneous transluminal coronary angioplasty

Abstract

Acute dissection of the left main coronary artery during diagnostic cardiac catheterization with selective coronary arteriography is an uncommon but recognized complication of the procedure. That similar dissection may occur during percutaneous transluminal coronary angioplasty is less well recognized. This report describes two cases of left main coronary dissection resulting in acute occlusion that occurred during percutaneous transluminal coronary angioplasty and demonstrates that survival with essentially complete functional recovery may result if immediate surgical intervention is undertaken. Recognition and treatment of this potentially catastrophic complication of angioplasty is described.

Iatrogenic left main coronary artery dissection

“…Amplatz catheter, small Judkins catheter resulting in deep LMCA intubation), stiffer and less manageable guide wires (e.g. pressure wire), unusual LMCA anatomy or location, operator experience, and presence of LMCA atherosclerosis have all been associated with an increased risk of dissection [2,3].…”

Bail‐out stenting for left main coronary artery dissection during catheter‐based procedure: Acute and long‐term results

“…Reported risk factors include the presence of atherosclerotic obstructive disease in LMCA disease and an unusual location or anatomy of the LMCA that necessitates extensive manipulation of catheter for entry. 5,8 Intravascular ultrasound (IVUS) examination has shown that there can be a discrepancy between angiographic and IVUS findings since normal-looking coronary artery segments are often seen to be diffusely diseased by IVUS; 9, 10 this could, at least in part, explain the development of dissection in 9 of 10 patients in this group with angiographically minimal or no plaque at LMCA. Therefore, angiographically normal-looking LMCAs as well as atherosclerotic obstructive LMCAs both may develop dissection during the procedure.…”

“…[2][3][4][5]11 In the present study, all patients with LMCA dissection were successfully treated with stent deployment. Treatment options for this complication include intracoronary stenting and emergency CABG.…”

“…In this circumstance, stent implantation could be the fastest technique in achieving vessel patency and stabilizing hemodynamic status. [2][3][4][5] We therefore assumed that prompt stent implantation for LMCA dissection is safe and associated with favorable clinical outcome. To test this hypothesis, we retrospectively evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure.…”

Late proximal coronary artery stenosis complicating percutaneous endovascular catheterisation procedures

“…However, as these endovascular procedures often require the catheters to abut on or even be seated in the coronary artery to achieve good quality angiograms or a steady platform for subsequent interventional processes, injury of the ostial/proximal coronary artery might consequently result, causing either acute intimal dissection [2][3][4][5][6] or delayed luminal stenosis [7][8][9][10][11][12][13]. The former complication almost invariably calls for immediate attention [2][3][4][5][6], whereas the latter usually remains occult initially, only to manifest at some later time [7][8][9][10][11][12][13]. Given the proximal location of the delayed coronary artery stenosis that may substantially impact the outcome of patients, knowledge of its presentation and manifestation represents a crucial yet inadequately learned lesson in performing catheterisation procedures.…”