When your tools turn against you; a nightmare for Interventional Cardiologist

Abstract

Background: One of the rarest but potentially life-threatening complications of coronary angiography and angioplasty is an iatrogenic dissection of the left main coronary artery (LMCA). Risk factors for left main dissection included coronary artery anomalies, atherosclerotic changes-left main stenosis, aortic root calcification, Marfan syndrome, arterial hypertension, older age, and bicuspid aortic valve4. Iatrogenic left or separate origin LAD/ LCX dissections result from catheter manipulation, forceful injection of contrast medium, balloon dilatation, and stenting.

Case Presentation: 54 year old hypertensive woman with family history of ischemic heart disease presented with unstable angina, who underwent iatrogenic dissection of anomalous origin of ostio-proximal left anterior descending artery.

Management: Patient received bail out percutaneous coronary intervention with drug-eluting stent (DES) 2.75 x 28 mm but there was distal shifting during deployment which resulted in placement of another DES 3.0 x 12 mm to cover the ostium.

Conclusion: A diagnostic catheter-induced proximal LAD dissection during a diagnostic coronary angiogram and bailout stenting of an anomalous left system course with an absent left main stem and separate origins of LAD and LCX was performed.