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Published on: May 28, 2019
Left main coronary artery dissection during percutaneous coronary intervention treated by stenting
Insights
Iatrogenic left main coronary artery dissection during percutaneous coronary intervention is rare. Stenting can be effective, but may require emergency surgery in some cases.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Iatrogenic left main coronary artery (LMCA) dissection is a rare but serious complication during percutaneous coronary intervention (PCI).
- Understanding the outcomes of LMCA dissection treated with stenting is crucial for patient management.
Purpose of the Study:
- To evaluate the outcomes of patients who developed LMCA dissection during PCI and were subsequently treated with stenting.
Main Methods:
- A retrospective review of a database identified patients who experienced LMCA dissection during PCI between 1996 and 2001.
- Medical records of these patients were analyzed to determine the cause, treatment, and outcomes.
Main Results:
- Eighteen patients (0.25%) developed LMCA dissection during PCI, primarily due to guiding catheters or stent/balloon procedures.
- All patients received LMCA stenting; 17% died within 10 days, and 22% required emergency surgery due to persistent ischemia.
- The remaining 56% of patients were free of cardiac complaints at a mean follow-up of 3.0 years, with no significant in-stent stenosis.
Conclusions:
- LMCA dissection during PCI can be successfully managed with stenting, particularly when localized.
- In cases of inadequate flow and hemodynamic instability, LMCA stenting can serve as a bridge to emergency coronary artery bypass grafting (CABG).
Aim:
Outcome after stenting for iatrogenic left main coronary artery (LMCA) dissection during percutaneous coronary intervention (PCI).
Methods:
From our database all patients with a PCI complicated by an LMCA dissection, between 1996 and 2001, were selected and medical records were reviewed.
Results:
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.
Conclusion:
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.
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