title: Spontaneous left main coronary artery dissection and the role of intravascular ultrasonography.
abstract: OBJECTIVE
  Spontaneous left main coronary artery (LMCA) dissection is a rare event with an unknown incidence and high risk of sudden cardiac death. The diagnosis of LMCA dissection is often challenging given the limitations of 2-dimensional angiography. The 3-dimensional perspective of intravascular ultrasonography (IVUS) is often indispensable in confirming or excluding the diagnosis of spontaneous LMCA dissection. We report 2 cases of spontaneous LMCA dissection with unique angiographic presentations wherein IVUS was essential in defining the extent of LMCA involvement and facilitated the subsequent referral for emergent coronary artery bypass grafting.
  
  
  METHODS
  Two patients presented to our facility with acute coronary syndrome prompting coronary angiography, which was notable for an unusual angiographic appearance of the LMCA. Intravascular ultrasonography was performed in each case, revealing spontaneous LMCA dissection.
  
  
  RESULTS
  Intravascular ultrasonography permitted the prompt diagnosis and aided in definitive surgical intervention in our 2 cases of spontaneous LMCA dissection.
  
  
  CONCLUSIONS
  Intravascular ultrasonography is a useful adjunctive imaging modality in the diagnosis and management of spontaneous LMCA dissection.
authors.affiliation: Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St Louis University School of Medicine, St Louis, Missouri, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Klein
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hudson
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kim
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018084:Ultrasonography, Interventional / Q000379:methods*