Bail-out stenting for left main coronary artery dissection during catheter-based procedure: acute and long-term results.
BACKGROUND
The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain.


OBJECTIVE
In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome.


METHODS
We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure in 10 patients.


RESULTS
Initially, there was no significant stenosis of LMCA segments in these patients. Catheter-induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra-aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in-hospital mortality. Six-month angiographic follow-up was performed in eight patients. No angiographic restenosis (diameter stenosis > or = 50%) was observed in any patient at follow-up study. During a mean follow-up of 31 +/- 25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization).


CONCLUSIONS
Bail-out LMCA stenting is technically feasible and showed good acute and long-term results in a small series of patients.
Lee
Seung-Whan
SW
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Hong
Myeong-Ki
MK
Kim
Young-Hak
YH
Park
Jae-Hyeong
JH
Rhee
Kyoung-Suk
KS
Lee
Cheol Whan
CW
Han
Ki-Hoon
KH
Song
Jong-Min
JM
Kang
Duk-Hyun
DH
Song
Jae-Kwan
JK
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D007723:Korea; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013995:Time; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form