A catastrophic nightmare of the interventional cardiologist: Iatrogenic left main artery dissection and longitudinal stent deformation

Abstract

Iatrogenic left main coronary artery dissection is a rare but potentially life-threatening complication of invasive coronary procedures. The newer generation drug eluting stents have shown a greater safety and efficacy compared to first generation drug eluting stents. We report a 60-year-old woman with iatrogenic left main coronary artery dissection who failed bailout stenting and underwent coronary artery bypass grafting. The strategy for managing left main coronary artery dissection is variable and depends upon the mechanism, the comorbidities of the patient and degree of hemodynamic stability. Longitudinal stent deformation is a rarely encountered complication but can be seen in complex lesions such as ostial, bifurcation and left main coronary artery lesions. The interventionists must be aware of this complication.

Management of iatrogenic left main coronary artery dissection in a center without onsite cardiac surgery back up

“…Especially in cases of very intense intracoronary calcification and severe atherosclerosis, or abnormal anatomic output of LMCA, LMCA dissections may occur due to subintimal passage of rigid and hydrophilic wires used during the procedure, inappropriate small diameter catheter selection, excessive manipulation of catheter, use of left amplatz and extra back up catheters and deep intubation of catheters, rapid and excessive contrast applications and operator-dependent reasons [3][4][5]. LMCA dissection management depends on the patient's clinical condition, the causative factor, antegrade flow and hemodynamic status and the character of the dissection line progression.…”

Spontaneous Coronary Artery Dissection Masquerading as Coronary Artery Stenosis in a Young Patient

“…Reports have suggested that there is instability of plaque and endothelial cell dysfunction in females associated with changes in estrogen and progesterone levels which in turn increases the stress of vessel walls and risk of dissection [18]. Vigorous injection of contrast, selection of larger catheters, inappropriate positioning of catheters, especially in patients with ostial lesions and subintimal passage of guidewire, are also associated with risk of CICD [19]. In our case, the patient presented with NSTEMI, was hemo-dynamically stable, had left main disease but no ostial lesion identified, and had a fixed defect on angiography and intravascular ultrasound without any distal propagation even with repeated contrast injections, therefore our patient had SCAD rather than CICD.…”

Longitudinal Stent Deformation at the Proximal Segment of the Left Main Coronary Artery Caused by a Stuck OCT Catheter: Case Report and Review of Literature

“…Our study was conducted based on previous studies and a review of LSD cases (Table 1 , Ref. [ 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]). Furthermore, we thoroughly examined the existing literature on LSD.…”

“…In contrast, other studies have reported that not all cases of LSD result in benign symptoms, with 14% of patients experiencing serious adverse events. These adverse events can include the need for heart bypass surgery due to the inability to remove the lodged medical device after LSD [ 8 ], acute stent thrombosis, subacute stent thrombosis, very late stent thrombosis [ 9 ], ISR, and death. Limited clinical studies have suggested that re-stenting or postdilatation management after the occurrence of LSD may reduce the incidence of adverse events associated with LSD.…”