• Incidence: five cases, 5 years and 2,700 PCI (0.2%)
• Mechanism: it appears that the entry point originates within the coronary artery dissection and subsequently leads to progressive retrograde dispersion of the subintimal space into the aortic root.
1. vigorous hand injection of contrast medium
2. subintimal passage of the guidewire
3. and/or inadvertent handling of the guiding catheter
4. underlying structural weakness of the media
5. extensive atherosclerosis
• Management:
1. Watchful waiting is a reasonable option in the hemodynamically stable patient with a low grade dissection.
2. The presence of hemodynamic instability is a clear indication for intervention.
3. In the few cases described in the literature to date, aortic involvement of 40 mm or more from the coronary ostium was considered a clear indication for surgical intervention

J Invasive Cardiol 2005;17:233-6

• Incidence: 13 cases, 0.071%
• Most of the patients were initially asymptomatic. Angiographic success was achieved in 11 of 13 patients (84.6%). Including one patient who underwent emergent CABG after a failed wiring attempt, two mortalities occurred in this series
• Mean follow-up duration of the ten patients discharged was 30.1+/-11.8 months, and no cardiac deaths occurred.
• Conclusions: Successful bail-out stenting resulted in good long-term survival and should be considered for initial management of iatrogenic LMCA dissection.

Int J Cardiol 2008;126:177-82