Coronary Artery Dissection in the Left Main Treated with Stenting in a Patient with Multiple Re-infarction – Case Report

Abstract

Introduction: In complex cases of multiple coronary artery stenosis, revascularization strategy could be essential for improving the life expectancy andqualityof life. However, major complications are sometimes encountered during interventions, such as rupture of the atheromatous plaque with consequent dissection of the coronary artery, causing an acute coronary syndrome which requires immediate intervention from the operator. In the absence of an experienced interventional cardiologist a complication like this can be fatal. Case presentation: We present the case of a 67-years old patient, male, with a known history of cardiovascular disease, who presented in our service complaining of chest pain with tightening character, irradiation in the shoulder and left arm, respectively shortness of breath and fatigue. The patient presented a history of multiple infarctions, intervention and stenting on RCA and circumflex artery. Computed Tomographic Coronary Angiography provided detailed information on the location of the target lesions and was followed by a revascularization procedure. However, despite the complex pre-interventional assessment, while trying to engage the guide in the emergence ofthe circumflex artery, atherosclerotic plaque rupture occurred, causing a dissection of the coronary wall which extended retrogradely into the left main, requiring a rapid response from the operator. A coronary stent was implanted into the left coronary artery trunk, treating the dissection. Conclusions: Coronary artery dissection is a very serious complication that can occur during a complex revascularization procedure, requiring immediate intervention in order to save the patient's life. IntroductionSpontaneous coronary artery dissection is a very rare cause of acute coronary syndromes in young otherwise healthy patients with a striking predilection for the female gender. It was reported for the first time in 1931 at the autopsy of a 42-year-old woman [1]. Pretty published the first case of coronary artery dissection [1], while Forker reported the first angiographic diagnosis of such a case [2]. However, coronary artery dissection is encountered more frequent during a revascularization procedure and can put the life of the patient at a significant risk. We present the case of a patient with multiple revascularization procedures in the history, who presented a dissection of the left coronary ostium during a percutaneous coronary intervention.