Left main trunk stenting in a case of acute aortic dissection: a case report

Abstract

In cases involving unstable hemodynamics in patients with Stanford type-A acute aortic dissection involving left main trunk (LMT) compression, LMT stenting without antiplatelet agents may be a good option as a bridge to surgery.

Keywords: Aortic dissection; myocardial infarction; percutaneous coronary intervention.

Figure 1

Electrocardiography and echocardiography findings. Admission electrocardiography revealed normal sinus rhythm with narrow QRS duration, ST‐segment elevation in lead aVR, and ST‐segment depression in leads I, II, III, aVL, aVF, and V4‐6. Echocardiography also revealed broad anterolateral akinesis without aortic regurgitation, pericardial effusion, or definite aortic flap. The diameter of the aortic root was 45 mm.

Figure 2

Computed tomography imaging. Plain computed tomography (CT) imaging demonstrated no definite AAD (on left). Contrast‐enhanced CT imaging after PCI demonstrated Stanford type‐A AAD (on right; a yellow arrow points out the false lumen of the ascending aorta). AAD, acute aortic dissection; PCI, percutaneous coronary intervention.

Figure 3

Coronary angiography and left ventriculography. (A) The left figure demonstrates the left coronary artery, and the right figure demonstrates the right coronary artery. Seventy‐five percent stenosis of LMT ostium was observed, as shown in the left figure (via a white arrow). (B) A bare‐metal stent (3.5 mm × 9 mm) was implanted into the LMT ostium and 2–3 mm into the aorta as a bridge to surgery with low pressure, so that a surgeon could pull out the stent during surgery. (C) Left ventriculography revealed compression of the true lumen of the ascending aorta from the false lumen of the ascending aorta during the beat as shown in the right figure (white arrows). LMT, left main trunk.

Figure 4

Intravascular ultrasound imaging. Intravascular ultrasound imaging revealed the false lumen at LMT proximal (note the yellow arrow, as shown in the left figure), which compressed the true lumen of LMT ostium (the midfigure). The false lumen was also observed in the ascending aorta (note the yellow arrow, as shown in the right figure). LMT, left main trunk.