Spontaneous left main coronary artery dissection treated with primary stenting

Area of Science:

• Cardiology
• Vascular Medicine
• Interventional Cardiology

Background:

• Spontaneous left main coronary artery (LMCA) dissection is a rare condition.
• It can lead to myocardial ischemia and sudden cardiac death.
• Defined as an intramural hematoma within the medial layer of the vessel wall.

Observation:

• A 56-year-old male with prior coronary artery bypass grafting presented with acute chest pain.
• Hemodynamic instability (BP 60/35 mmHg) and ECG changes indicated acute ischemia.
• Coronary angiography revealed complete LMCA occlusion due to a dissection flap.

Findings:

• A dissection flap was obstructing the true lumen of the LMCA.
• Percutaneous coronary intervention with a bare metal stent was performed after flap fenestration.
• Successful restoration of TIMI 3 flow in the circumflex artery was achieved.
• Follow-up CT angiography showed false lumen thrombosis beneath the stent.

Implications:

• Primer stenting can be a successful treatment for spontaneous LMCA dissection.
• This case highlights a potential therapeutic strategy for this uncommon emergency.
• Further research may explore optimal management for spontaneous coronary artery dissections.