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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
13:10

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[Primary Percutaneous Coronary Intervention for Acute Aortic Dissection with Left Coronary Artery Malperfusion:Report

Koki Aiso1, Hisato Takagi

  • 1Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 7, 2026
PubMed

Insights

Acute aortic dissection extending into the left main coronary artery is a rare emergency. Prompt percutaneous coronary intervention under cardiopulmonary support can improve outcomes in these critical cases.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Left main coronary artery (LMCA) malperfusion is a rare but critical complication of acute aortic dissection (AAD).
  • Patients often present with cardiogenic shock and high risk of cardiopulmonary arrest.
  • Early diagnosis and intervention are crucial for survival.

Purpose of the Study:

  • To report a case of LMCA malperfusion secondary to Stanford type A AAD.
  • To highlight the successful management using percutaneous coronary intervention (PCI) and percutaneous cardiopulmonary support (PCPS).
  • To emphasize the benefits of primary PCI in reducing myocardial ischemic time.

Main Methods:

  • A 64-year-old male presented with chest pain and ST-segment changes suggestive of acute coronary syndrome.
  • Coronary angiography revealed LMCA stenosis; intravascular ultrasonography confirmed dissection extending into the LMCA.
  • The patient underwent emergent PCI with a drug-eluting stent under PCPS, followed by ascending aortic replacement.

Main Results:

  • Successful PCI restored LMCA flow, and PCPS supported the patient through cardiogenic shock.
  • Postoperative CT confirmed Stanford type A AAD, and ascending aortic replacement was performed.
  • Echocardiography demonstrated preserved cardiac function post-surgery.

Conclusions:

  • Primary PCI under PCPS for AAD with LMCA malperfusion is a viable strategy.
  • This approach can significantly shorten myocardial ischemic time.
  • Improved outcomes and prognosis can be achieved with timely intervention.

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