When your tools turn against you; a nightmare for Interventional Cardiologist
Keywords:Left main coronary artery, Iatrogenic dissection, Anomalous origin, Bail out PCI, Type of dissection.
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.
Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seiler C, Meier B, Windecker S, Carrel T, Wenaweser P, Cook S. Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up. American heart journal. 2010;159(6):1147-1153.
Onsea K, Kayaert P, Desmet W, Dubois CL. Iatrogenic left main coronary artery dissection. Netherlands Heart Journal. 2011;19(4):192-195.
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.
Kovac JD, De Bono DP. Cardiac catheter complications related to left main stem disease. Heart. 1996;76(1):76-78.
How to Cite
Copyright (c) 2021 The Author
This work is licensed under a Creative Commons Attribution 4.0 International License.