When your tools turn against you; a nightmare for Interventional Cardiologist

Authors

  • Bilal Ahmed Mayo Hospital, Lahore-Pakistan
  • Furqan Yaqub Pannu Mayo Hospital, Lahore-Pakistan
  • Bilal S Mohydin Mayo Hospital, Lahore-Pakistan

Keywords:

Left main coronary artery, Iatrogenic dissection, Anomalous origin, Bail out PCI, Type of dissection.

Abstract

Background: One of the rarest but potentially life-threatening complications of coronary angiography and angioplasty is an iatrogenic dissection of the left main coronary artery (LMCA). Risk factors for left main dissection included coronary artery anomalies, atherosclerotic changes-left main stenosis, aortic root calcification, Marfan syndrome, arterial hypertension, older age, and bicuspid aortic valve4. Iatrogenic left or separate origin LAD/ LCX dissections result from catheter manipulation, forceful injection of contrast medium, balloon dilatation, and stenting.

Case Presentation: 54 year old hypertensive woman with family history of ischemic heart disease presented with unstable angina, who underwent iatrogenic dissection of anomalous origin of ostio-proximal left anterior descending artery.

Management: Patient received bail out percutaneous coronary intervention with drug-eluting stent (DES) 2.75 x 28 mm but there was distal shifting during deployment which resulted in placement of another DES 3.0 x 12 mm to cover the ostium.

Conclusion: A diagnostic catheter-induced proximal LAD dissection during a diagnostic coronary angiogram and bailout stenting of an anomalous left system course with an absent left main stem and separate origins of LAD and LCX was performed.

References

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Celik M, Yuksel UC, Yalcinkaya E, Gokoglan Y, Iyisoy A. Conservative treatment of iatrogenic left main coronary artery dissection: report of two cases. Cardiovascular diagnosis and therapy. 2013;3(4):244.

Awadalla H, Sabet S, El Sebaie A, Rosales O, Smalling R. Catheter-induced left main dissection incidence, predisposition and therapeutic strategies experience from two sides of the hemisphere. J Invasive Cardiol. 2005;17(4):233-236.

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Published

01-12-2021

How to Cite

Ahmed, B., Yaqub Pannu, F., & Mohydin, B. S. (2021). When your tools turn against you; a nightmare for Interventional Cardiologist. Pakistan Journal of Cardiovascular Interventions, 1(1), 07–12. Retrieved from https://www.pjcvi.com/index.php/home/article/view/13