Left main coronary artery dissection during percutaneous coronary intervention treated by stenting

Outcome after stenting for iatrogenic left main coronary artery (LMCA) dissection during percutaneous coronary intervention (PCI).

From our database all patients with a PCI complicated by an LMCA dissection, between 1996 and 2001, were selected and medical records were reviewed.

Eighteen patients out of 7199 (0.25%) were found with an LMCA dissection during a PCI for unstable (n=14) and stable angina (n=4). Antegrade dissections were caused by guiding catheters (n=6). Retrograde dissections were caused by stent implantation (n=7) and balloon angioplasty (n=5). All patients were treated by stent implantation in the LMCA. Three patients died (17%) within ten days of the procedure. Emergency surgery was performed in four patients (22%) because of persistent ischaemia due to low coronary flow. One patient was operated one day later because of unstable angina and a failed attempt to recanalise the left descending coronary artery. The other ten patients (56%) with a stent in the LMCA were free of cardiac complaints after a follow-up period of 3.0 years (range 1.9-5.0). Cardiac catheterisation in six patients between three and eight months did not show stenosis of the LMCA stent.

LMCA dissection during a PCI can be treated by stent implantation, especially when the dissection is limited to the LMCA. When flow cannot be restored adequately, resulting in ischaemia and haemodynamic instability, LMCA stenting may serve as a bridge to emergency CABG.