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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection

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Novel use of a guiding catheter to relieve left main stem occlusion complicating Stamford type A aortic dissection

James A Cockburn1, Shahzad M Munir1, Bernard D Prendergast2

  • 1Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.

Journal of Cardiology Cases
|December 12, 2018
PubMed

Insights

Acute aortic dissection can cause myocardial infarction, often with fatal outcomes. A novel technique using a guiding catheter successfully relieved left main coronary artery obstruction, bridging the patient to surgery.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Acute aortic dissection is a rare but often fatal cause of ST-elevation myocardial infarction.
  • Left main coronary artery (LMCA) ostial obstruction by dissection flap is a critical complication.
  • Optimal management strategies for this specific scenario remain challenging.

Observation:

  • A patient with acute chest pain and ST-elevation myocardial infarction presented with Stanford type A aortic dissection.
  • Coronary angiography revealed mechanical LMCA occlusion due to the dissection flap.
  • Primary percutaneous coronary intervention was initiated.

Findings:

  • A percutaneous guiding catheter was used to engage the coronary ostium.
  • Engagement of the ostium with the guiding catheter successfully relieved the LMCA obstruction.
  • This intervention served as a crucial bridge to successful surgical repair.

Implications:

  • Percutaneous guiding catheter use offers a novel approach to manage LMCA occlusion in aortic dissection.
  • This technique can stabilize patients, facilitating transfer for definitive surgical treatment.
  • It highlights the potential for interventional cardiology to improve outcomes in complex cardiovascular emergencies.

Keywords:
Aortic dissectionLeft main stemMyocardial infarction

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