Successful bailout stenting strategy against lethal coronary dissection involving left main bifurcation

Abstract

Catheter-induced coronary dissection involving left main bifurcation is a rare complication during cardiac catheterization but can become lethal unless it is treated appropriately. Interventional cardiologists always have to pay attention to the risk of complications related to cardiac catheterization and prepare for determining the best bailout strategy for the situation.

Keywords: Bailout stenting; coronary dissection; iatrogenic; left main bifurcation.

Figure 1

No significant organic stenosis was observed in the left coronary artery. (A) Antero‐posterior and cranial view. (B) Right anterior oblique and caudal view.

Figure 2

Spiral coronary dissection occurred and rapidly spread out in the three directions of the proximal LMCA, LAD, and LCX coronary arteries (A, B Arrows). Coronary blood flow in both the LAD and LCX coronary arteries was interrupted by a coronary hematoma (B Arrowheads). An IVUS image demonstrated the guidewire passing through the appropriate intraluminal space of the LAD coronary artery. Asterisks indicate the dissected lumen. Arrows indicate the guidewire passing from the LMCA to LCX coronary artery (lower row).

Figure 3

Bailout PCI procedure for the lethal coronary dissection involving LM bifurcation. (A) Guidewires passed in both arteries under IABP support. (B) A DES was deployed from LMCA to the LCX coronary artery. (C) After crushing the proximal segment of the initially deployed DES protruding in LMCA, another DES was deployed from LMCA to the LAD coronary artery. (D) After recrossing a guidewire to the LCX coronary artery, KBI was performed. Final angiography demonstrated sufficient blood flow without delay. (E) Antero‐posterior and cranial view. (F) Antero‐posterior and caudal view.