Retrograde iatrogenic left main dissection (original) (raw)
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)
Spontaneous left main dissection treated by percutaneous coronary intervention
Revista Portuguesa de Cardiologia, 2013
Spontaneous coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death. The clinical presentation is highly variable and prognosis varies widely, depending mainly on how rapidly it is diagnosed. Prompt treatment is also essential, and includes medical management, percutaneous coronary intervention and surgical revascularization. We describe the case of a young woman presenting with spontaneous coronary artery dissection of the left main coronary artery, first diagnosed as coronary thrombus, who underwent successful percutaneous coronary stenting. This report highlights the need to include spontaneous coronary artery dissection in differential diagnosis of chest pain in young women and that distinguishing between coronary thrombus and coronary artery dissection is not always straightforward. To our knowledge this is the fourth case of left main stenting in a patient with spontaneous coronary artery dissection described in the literature.
Left main coronary artery dissection during percutaneous transluminal coronary angioplasty
Catheterization and Cardiovascular Diagnosis, 1986
Acute dissection of the left main coronary artery during diagnostic cardiac catheterization with selective coronary arteriography is an uncommon but recognized complication of the procedure. That similar dissection may occur during percutaneous transluminal coronary angioplasty is less well recognized. This report describes two cases of left main coronary dissection resulting in acute occlusion that occurred during percutaneous transluminal coronary angioplasty and demonstrates that survival with essentially complete functional recovery may result if immediate surgical intervention is undertaken. Recognition and treatment of this potentially catastrophic complication of angioplasty is described.
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.
Cardiovascular Revascularization Medicine, 2012
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Knowledge of this condition is scarce and, at present, no consensus exists with regards to the aetiology, prognosis, and treatment. Among patients with SCAD, cases involving the left main (LM) and the left anterior descending (LAD) and circumflex (Cx) arteries bifurcation are even more exceptional. Furthermore, the treatment of asymptomatic patients with involvement of these major vessels poses a major challenge for the cardiologists and cardiac surgeons. We report a case of complicated spontaneous left main coronary artery dissection in which we question what is the best initial treatment in these asymptomatic patients: conservative or early aggressive.
Spontaneous coronary dissection treated with directional coronary atherectomy
Catheterization and Cardiovascular Diagnosis, 1993
We report a case of spontaneous coronary dissection occurring in a middle aged male which was treated with thrombolytic therapy and directional coronary atherectomy. This technique provides a new option for treating thls entity in the cardiac catheterization laboratory. o 1993 WilOpLi8S, iw.
Outcomes Following Conservative Management of Spontaneous Coronary Artery Dissection
Heart, Lung and Circulation, 2014
Background Spontaneous coronary artery dissection (SCAD) is a rare but a serious cause of myocardial ischaemia and infarction that occurs most frequently in younger female patients. The management of this rare condition remains controversial. In this case series we describe the spectrum of outcomes observed following conservative management. Case 1 A 33 year-old multiparous female, with no recent history of pregnancy, presented to a peripheral hospital with one-hour history of central heavy chest pain. She was a current smoker and was taking an oral combined contraceptive. No other risk factors for coronary artery disease were identified. Physical examination was unremarkable. Anterior ST-segmentelevation was demonstrated on an electrocardiogram and fibrinolysis was successfully administered. The peak serum high sensitivity troponin T was 3134 ng/L (ULN <13 ng/L) the day following presentation. Standard medical therapy was continued for the acute coronary syndrome (ACS) and coronary angiography was undertaken, following transfer to 32 our centre, two days later. This revealed a coronary artery 33 dissection involving the origin of the left anterior descending 34 artery (LAD) and extending to the distal vessel with throm-35 bolysis in myocardial infarction (TIMI) 3 flow in the vessel 36 [Fig. 1A]. The other coronary arteries appeared angiograph-37 ically normal but the left ventricular function was moder-38 ately reduced with anterior akinesis demonstrated. Medical 39 management was continued and she was discharged five 40 days later with no ongoing symptoms. 41 A cardiac MRI performed two weeks post presentation 42 demonstrated 50-75% thickness scar in the LAD territory 43 with overall moderately reduced left ventricular ejection 44 fraction (LVEF). The patient remained asymptomatic and 45 coronary angiography performed five weeks later demon-46 strated a persisting dissection with a large false lumen 47 extending from the distal left main coronary artery (LMCA) 48 to the distal LAD with compression of the true lumen of the 49 LAD. [Fig. 1B]. There was concern regarding involvement of 50 the distal LMCA. A consensus opinion was sought from the 51 Cardiosurgical (Heart) team and continued medical manage-52 ment was suggested with close observation and repeat coro-53 nary angiography to exclude progressive involvement of 54 the LMCA. The third coronary angiogram was undertaken Spontaneous coronary artery dissection (SCAD) is a rare but a serious cause of myocardial ischaemia and infarction that occurs most frequently in younger female patients. The management of this rare condition remains controversial. In this case series we describe the spectrum of outcomes observed following conservative management.