Percutaneous coronary intervention for iatrogenic left main coronary artery dissection.
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.
Cheng
Cheng-I
CI
The Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
Wu
Chiung-Jen
CJ
Hsieh
Yuan-Kai
YK
Chen
Yen-Hsun
YH
Chen
Chien-Jen
CJ
Chen
Shyh-Ming
SM
Yang
Cheng-Hsu
CH
Hung
Wei-Chin
WC
Yip
Hon-Kan
HK
Chen
Mien-Cheng
MC
Fu
Morgan
M
Fang
Chih-Yuan
CY
D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003323:Coronary Aneurysm / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies