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

Abstract

SummaryBackground: The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheterbased procedure remains uncertain.Hypothesis: In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome.Methods: We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure in 10 patients.Results: Initially, there was no significant stenosis of LMCA segments in these patients. Catheter-induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra-aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in-hospital mortality. Six-month angiographic follow-up was performed

Iatrogenic left main coronary artery dissection

“…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.…”

Severe Stenosis of the Left Main Coronary Artery Detected on Electrophysiologic Study

“…8)9) Even though the standard treatment of LMCA stenosis is coronary artery bypass graft surgery, 10) percutaneous revascularization of the LMCA may be a lifesaving procedure in the setting of ongoing ischemia as a bail-out procedure for treating iatrogenic LMCA injury in the catheterization laboratory. [11][12][13] Myocardial ischemic symptoms in the elderly are often absent or atypical compared with young patients. 15) Asymptomatic myocardial ischemia can be documented during ambulatory ECG monitoring, but this was not found in the present case.…”

Percutaneous coronary intervention for iatrogenic left main coronary artery dissection

“…Iatrogenic left main coronary (LMCA) dissection is a rare complication of coronary catheterization with a reported incidence of b 0.1% [1][2][3][4]. This fatal complication is typically caused by manipulation of a guiding catheter or coronary intervention device [2].…”