Optimal Wiring Direction in Iatrogenic Left Main Coronary Artery Dissection: Clinical Cases and Bench Validation

Area of Science:

• Interventional Cardiology
• Cardiovascular Imaging

Background:

• Iatrogenic left main coronary artery dissection is a complication of cardiac catheterization.
• Intracoronary imaging aids in evaluating these dissections, but optimal management strategies are debated.

Purpose of the Study:

• To determine the optimal initial wiring direction for iatrogenic left main coronary artery dissection.

Main Methods:

• Analysis of 4 cases of iatrogenic left main coronary artery dissection.
• Bench analysis of common left coronary catheters' alignment.
• Evaluation of wiring strategies in the left anterior oblique projection.

Main Results:

• Dissection entry was consistently on the epicardial side, with the true lumen on the myocardial side.
• Standard left coronary catheters tend to align toward the epicardial side.
• Wiring toward the myocardial side demonstrated potential for rapid flow restoration.

Conclusions:

• Wiring toward the myocardial side is a promising strategy for rapid true lumen access in iatrogenic left main dissection.