Percutaneous coronary intervention for iatrogenic left main coronary artery dissection

Iatrogenic left main coronary artery dissection

“…Long-term outcome of emergent LMCA bail-out stenting in a group of 13 patients [4] was similar to that of elective percutaneous treatment of an unprotected LMCA, with a binary restenosis rate of 30% of the LMCA segment (3 patients) at 5±2 months follow-up. In another report, Lee and colleagues [5] reported no significant LMCA restenosis on 6-month follow-up angiogram of ten urgently treated patients, which was attributed to the minimal plaque burden in the iatrogenically dissected LMCA, leading to less in-stent neo-intimal proliferation.…”

“…Nevertheless, even in case of initial TIMI 3 flow and haemodynamic stability, rapid deterioration may occur shortly after because of abrupt flow compromise due to progressive dissection or superimposed thrombus formation, which is why it seems imperative to always envisage a 'revascularisation plan' by PCI or CABG. A literature review by Cheng et al [4] ( Table 1) of 36 patients who underwent stenting of an iatrogenic LMCA dissection showed a favourable immediate outcome with achievement of procedural, angiographic success in 32 patients (88.9%). Four patients needed emergent CABG of whom 2 eventually died.…”

Catheter-induced in-stented segment coronary dissection

“…Cheng-I Cheng recently reported a prevalence of 0.071% (13 cases) LMCA catheter-induced dissection in 18,400 angiographic procedures [4].…”

Inadvertent left aorto-coronary dissection following percutaneous coronary intervention treated successfully by bail-out left main coronary artery stenting

“…1 Though the optimal treatment of patients with LMCA dissection during catheter-based procedure still remains unclear, but in cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome. 2 We describe a case of guiding catheter induced aorto-coronary dissection following successful angioplasty during removal of angioplasty balloon with no flow situation in LMCA complicated by cardiac arrest. He was resuscitated successfully by LMCA stenting and kissing balloon angioplasty of both left anterior descending (LAD) & left circumflex (LCX) artery ostium.…”