Retrograde iatrogenic left main dissection (original) (raw)
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Percutaneous coronary intervention for iatrogenic left main coronary artery dissection
International Journal of Cardiology, 2008
Background: Although catheter-induced left main coronary artery (LMCA) dissection is a rare complication of coronary catheterization, it is a common cause of periprocedural mortality. Emergent coronary artery bypass surgery (CABG) is the mainstay for managing this acute complication. However, hemodynamic deterioration may progress while patients await emergent CABG; consequently, a high postoperative mortality rate has been reported. Although the number of cases was small, prompt bail-out stenting for iatrogenic LMCA dissection had reportedly reversed this complication with favorable clinical outcomes. Methods: This study included 13 cases of attempted stenting for iatrogenic LMCA dissection classified as grades C-F based on the National Heart, Lung and Blood Institute (NHLBI) classification system. Angiographic success, in-hospital mortality and long-term outcomes were analyzed. Results: The incidence of iatrogenic LM dissection was 0.071%. Most of the patients were initially asymptomatic. Angiographic success was achieved in 11 of 13 patients (84.6%). Including one patient who underwent emergent CABG after a failed wiring attempt, two mortalities occurred in this series. Mean follow-up duration of the ten patients discharged was 30.1 ± 11.8 months, and no cardiac deaths occurred. Follow-up angiogram of eight patients with a mean interval of 5.2 ± 2.3 months after initial event demonstrated restenosis in three patients occurring either at the ostiums of the left anterior descending artery or left circumflex artery. Revascularization was performed on two patients. Conclusions: Successful bail-out stenting resulted in good long-term survival and should be considered for initial management of iatrogenic LMCA dissection.
American Heart Journal, 2010
Background Although rare, iatrogenic left main coronary artery (LM) dissection is a feared complication of coronary catheterization. Its incidence, optimal therapeutic management, and prognosis remain largely unknown. The aim of the present study was to estimate the incidence, characterize the population at risk, depict the initial management, and evaluate the long-term prognosis of iatrogenic LM dissection.
Vojnosanitetski pregled, 2016
Introduction. Left main coronary artery dissection is a rare and potentially life-threatening complication of coronary angiography and angioplasty which requests urgent revascularization. Case report. During the period between 2010 and November 2014 at single healthcare center we did totally 8,884 coronary procedures, out of which 2,333 were percutaneous coronary interventions (PCI). In this period we had a total of 3 (0,03%) left main coronary artery dissections, and all of them were successfully treated by PCI. We presented three cases with iatrogenic dissection of the left main coronary artery, occurred during elective diagnostic procedures, successfully treated with PCI with different techniques. Conclusion. PCI could be fast and life-saving approach in iatrogenic dissections of the left main coronary artery.
Iatrogenic left main artery dissection: A catastrophic complication
Experimental and clinical cardiology, 2012
Iatrogenic left main artery (LM) dissection is a catastrophic complication of coronary angiography and angioplasty that requires prompt management using stenting. Although LM dissection can be prevented, it cannot always be avoided and has a reported incidence rate of 0.02%. In the present report, a case of iatrogenic LM dissection that was successfully treated with multiple stents is presented and followed by a brief review of the literature.
Clinical Cardiology, 1988
This case report describes a patient with severe discrete left anterior descending coronary artery atheroma who underwent percutaneous transluminal coronary angioplasty. During the procedure, dissection occurred in a superior atheromatous plaque of the left main coronary artery and needed immediate surgery. Special care should be taken in the selection and angioplasty of patients with concomitant left main artery disease.
Journal of Case Reports, 2020
Background: Catheter-induced left main coronary artery (LMCA) dissection, though quite rare, is one of the most dreaded and life-threatening complication of coronary intervention and requires urgent management because if not promptly diagnosed and treated with myocardial revascularization, it can have fatal consequences. Case Report: Here, we report a case iatrogenic dissection of left main coronary artery by vigorous manipulation of extra backup (EBU) guiding catheter in a 73-year old male during revascularization of proximal left anterior descending artery which was successfully bailed out by stenting of left main artery using 4×23 mm Xience Prime everolimus eluting stent (Abott Vascular; USA) at 12 atm pressure achieving complete sealing of flap with TIMI III flow. Conclusion: Coronary artery dissection can be precipitated by catheter manipulation.
International Journal of Cardiology, 2016
ABBREVIATIONS CA, coronary angiography CABG, coronary artery by-pass graft CAD, coronary artery dissection DES, drug eluting stent GC, guidind catheter GW, guide wire LAD, left anterior descending LMCA, left main coronary artery PCI, percutaneous coronary intervention
Korean Circulation Journal, 2012
Although rare, iatrogenic aortocoronary dissection is one of the complications most dreaded by the interventional cardiologist. If not managed promptly, it can have redoubted and serious consequences. Herein, we present the case of a 70 year-old woman who was treated by stenting of the second segment of the right coronary artery (RCA) for recurrent angina but, unfortunately, the procedure was complicated by anterograde dissection of the RCA with a simultaneous retrograde propagation to the proximal part of the ascending aorta. Successful stenting of the entry point was able to recuperate the RCA and to limit the retrograde propagation to the ascending aorta, but there was an extension of the dissection to the aortic valve leaflets resulting in a massive aortic insufficiency. Therefore, an isolated surgical aortic valve replacement was performed. (Korean Circ J 2012;42:504-506)
Surgical management of spontaneous left main coronary artery dissection
The Annals of Thoracic Surgery, 1998
4]. The major limitation of angioscopy of vessels, without any doubt, is the large volume of blood within, which hinders adequate visualization. Use of total circulatory arrest under conditions of profound hypothermia, as proposed in this work, resolved part of the problem. Since 1969, aneurysms of the abdominal aorta have been treated with stents deployed percutaneously [5]. Stents also have been used to treat aneurysms and dissection of the aorta [6, 7] and complications of aortic dissection [8]. Our current research and clinical work on endoscopic stent placement under deep hypothermic circulatory arrest offers a promising perspective of the technique to treat a variety of pathologic conditions of the aorta in the future. This technique will facilitate the management of complex cases, probably with low morbidity and mortality. References 1. Brock RC. Surgical treatment of aortic stenosis. Br Med J 1957; 1:1019-28. 2. Palma JH, Almeida DR, Carvalho AC, Andrade JC, Buffolo E. Surgical treatment of acute type B aortic dissection using an endoprosthesis (elephant trunk). Ann Thorac Surg 1997;63: 1081-4. 3. Vollmar JB, Storz LW. Vascular endoscopy: possibilities and limits of its clinical application. Surg Clin North Am 1974;54: 111-22. 4. Lee G, Ikeda RM, Dwyer RM. Feasibility of intravascular laser irradiation for in vivo visualization and therapy of cardiocirculatory diseases. Am Heart J 1982;103:1076-7. 5. Dotter CT. Transluminally placed coilspring endarterial tube grafts: long term patency in canine popliteal artery. Invest Radiol 1969;4:329-32. 6. Dake MD, Miller DC, Semba CP, Mitchell R, Walker PJ, Liddel RP. Transluminal placement of endovascular stentgrafts for the treatment of descending thoracic aortic aneurysm. N Engl J Med 1994;331:1729-34. 7. Marin ML, Veith FJ, Panetta F, et al. Transluminally placed endovascular stent-graft repair for arterial trauma. J Vasc Surg 1994;20:466-73. 8. Slonim SM, Nyman U, Semba CP, Miller DC, Mitchell S, Dake MD. Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration.