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Iatrogenic propagation of left main coronary artery dissection during diagnostic coronary angiography: A case report

Nghia Thuong Nguyen1, Nga Anh Thi Nguyen2, Hai Phuong Nguyen Tran3

  • 1Department of Interventional Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.

Medicine
|April 7, 2025
PubMed

Insights

Prompt management of iatrogenic left main coronary artery (LMCA) dissection, a rare complication during coronary intervention, is crucial. This case demonstrates successful treatment using intravascular ultrasound-guided stenting, ensuring optimal outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Iatrogenic dissection of the left main coronary artery (LMCA) is a rare but severe complication of coronary interventions.
  • Prompt diagnosis and management are critical for patient survival and improved outcomes.

Purpose of the Study:

  • To report a case of successful management of iatrogenic LMCA dissection extending to the LAD and left circumflex arteries.
  • To emphasize the role of intravascular ultrasound (IVUS) in optimizing stent placement in complex dissections.

Main Methods:

  • A 78-year-old male with angina underwent coronary angiography, during which iatrogenic LMCA dissection occurred.
  • The dissection was treated with provisional stenting from LMCA to LAD, guided by IVUS for optimal stent expansion and apposition.
  • Proximal optimization technique (POT) was utilized for further stent optimization.

Main Results:

  • The patient's angina resolved immediately post-procedure.
  • Hemodynamic stability was maintained throughout the follow-up period.
  • A 6-month follow-up angiogram confirmed patent stents without complications.

Conclusions:

  • Iatrogenic LMCA dissection requires prompt recognition and intervention to prevent catastrophic outcomes.
  • IVUS-guided stent optimization is essential for successful outcomes in managing complex coronary dissections.
  • This case underscores the importance of meticulous technique and advanced imaging in interventional cardiology.
Abstract

Keywords:
iatrogenic coronary artery dissectionleft main coronary artery dissection

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