IVUS-Guided Rescue of Catheter-Induced Left Main Coronary Artery Dissection

Catheter-induced left main coronary artery (LMCA) dissection is a rare but life-threatening complication of coronary angiography requiring rapid recognition and expert management. We report a 72-year-old hypertensive female who developed a National Heart, Lung, and Blood Institute (NHLBI) Type-F dissection of the LMCA extending into both the left anterior descending (LAD) and circumflex (LCx) arteries during guiding catheter engagement for left coronary angiography. The dissection resulted in abrupt LAD occlusion with TIMI 0 flow and acute ST-segment elevation. Intravascular ultrasound (IVUS) revealed that both guidewires had inadvertently tracked into the false lumen, a finding that would have led to catastrophic outcomes if unrecognized. Under real-time IVUS guidance, the operator successfully redirected the wire into the true LAD lumen, followed by drug-eluting stent deployment from LMCA to LAD with proximal optimization technique (POT), LCx balloon angioplasty to decompress the subintimal hematoma, and final kissing balloon inflation restoring TIMI-III flow in both vessels. The patient remained hemodynamically stable and was asymptomatic at 6-month follow-up. This case underscores the critical and potentially life-saving role of IVUS in achieving true-lumen re-entry and successful percutaneous management of complex LMCA dissections without the need for emergency surgical intervention.