Catheter Catastrophe: Facing Left Main Dissection in the Cath Lab

Abstract

Background: Iatrogenic left main dissection is a serious complication that can arise during coronary interventions, significantly increasing the risk of myocardial infarction and mortality. Understanding the clinical presentation and management strategies for such complications is critical for improving patient outcomes. This case discusses an acute coronary syndrome patient diagnosed with Wellen’s syndrome, emphasizing the importance of early recognition and effective intervention.

Case Presentation: A 62-year-old hypertensive female presented with a 3-day history of chest pain. The ECG demonstrated Wellen’s pattern characterized by deep, symmetrical T wave inversions in the precordial leads. Baseline investigations indicated elevated troponin levels and echocardiographic findings of anterior wall hypokinesia with an ejection fraction (EF) of 48%. The patient was subsequently admitted to the cardiology ward for coronary angiography.

Results: Angiography revealed significant disease in the left anterior descending artery (LAD). During the angioplasty procedure, a simultaneous catheter-induced left main stem (LMS) dissection occurred, along with wire-induced distal stent edge dissection. Both complications were managed successfully.

Conclusion: Iatrogenic left main dissection is a catastrophic complication that, while preventable, cannot be entirely avoided. It requires urgent recognition and prompt management to minimize adverse outcomes.