Catheter‐Induced Dissection of the Left Main Coronary Artery With and Without Extension to the Aortic Root:

Abstract

Catheter-induced left main coronary artery dissection is quite rare. We describe two cases of iatrogenic left main coronary artery dissection. In the first case, the aortic root was involved in the dissection process, and stenting of the entry point did not halt the progression of dissection. In the second case, the dissection did not involve the aortic root.

Acute myocardial infarction due to an acute type A aortic dissection involving the left main coronary artery

“…8 The aetiology of this life-threatening situation is an iatrogenic dissection involving the sinus of Valsalva and the ascending aorta by forceful manipulation of the guide catheter. 9,10 Another cause may be a spontaneous aortocoronary dissection involving the sinus of Valsalva and the ascending aorta or a retrograde propagation of a spontaneous dissection of the left coronary artery to the sinus of Valsalva.…”

Percutaneous coronary intervention for iatrogenic left main coronary artery dissection

“…Although this patient in our study died within 24 h following emergent CABG, early utilization of ECMO may be a crucial bridge to subsequent CABG after failed PCI in this situation. Additionally, in studies by Garcia-Robles et al [8] and Awadalla et al [13], PCI was unsuccessfully performed in two patients due to retrograde dissection to the aortic cuspid and potential compromise of LCX flow due to failure of wire protection. Unlike the technique using double-wire [12] for iatrogenic RCA dissection (one wire occupies the false lumen to facilitate passage of the second wire into the true lumen), triple wires may be required in these difficult cases (one wire in the false lumen, one in the LAD and the third in the LCX), which would be time consuming and increase procedural complexity.…”

“…Therefore, despite the high success rate of bailout stenting in iatrogenic LMCA dissection, notification of cardiovascular surgeons and preparation for emergent CABG should commence immediately after dissection is recognized in cases of PCI failure. Table 3 lists the medical literature [2,4,6,[13][14][15][16][17] relevant to bail-out stenting for iatrogenic LMCA dissection extracted from the PubMed database. Including the 13 patients in our study, thirty-six patients with grades C-F iatrogenic LMCA dissection underwent a stenting-first strategy.…”

Significant left main coronary artery disease from iatrogenic dissection during coronary angiography

“…The dissection may lead to progressive retrograde dissection, to complete coronary occlusion, or ascending aortic dissection [2,3].…”