Cardiac catheter complications related to left main stem disease.

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].…”

Percutaneous coronary intervention for iatrogenic left main coronary artery dissection

“…This proportion of asymptomatic patients in the current study was higher than that in the UK Confidential Enquiry into Cardiac Catheter Complications (CECCC) database, [7] and was due to some cases of iatrogenic LMCA dissection occurred during or after PCI when a guidewire had been placed in the LAD. Early recognition of dissection and prompt bail-out stenting may have prevented development of angina and hemodynamic deterioration.…”

“…No definite risk factor was previously identified for this life-threatening complication [7]; however, studies have proposed that atherosclerotic disease [11] and extensive catheter manipulation [7] are associated with iatrogenic LMCA dissection. This study had a disproportionally high percentage of males (86.4%).…”

“…Progressive stenosis at the LMCA with refractory angina may occur if iatrogenic LMCA dissection is left untreated [5,6]. Although emergent coronary artery bypass surgery (CABG) is the most frequent therapeutic strategy, the 30-day mortality rate remains as high as 26% following a successful CABG [7].…”

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.…”