Slides
Bail-Out Stenting for Significant Left Main Coronary Artery Dissection During Guiding-Catheter Manipulation
- Operator : Seung-Jung Park
Bail-Out Stenting for Significant Left Main Coronary Artery Dissection During Guiding-Catheter Manipulation |
- Operator: Seung-Jung Park, MD, PhD |
Case Presentation |
The patient was 61 year-old female. She had a history of unstable angina and underwent stenting at mid LAD, proximal RCA, and mid RCA 6 months ago. She was admitted for follow-up angiography due to chest discomfort. |
Procedure |
Follow-up coronary angiography was performed with a 7F Judkins catheter with 3.5 cm curve via radial approach. Engagement of guiding catheter was easily made. After initial contrast injection, contrast stasis and linear dissection was noted from left main to distal segment of LCX with TIMI 2 flow and blood pressure was dropped to 90/50mmHg (Figure 1, Figure 2). Thus we decided to treat this catastrophic complication with stent implantation. Dopamine was intravenously administrated and shock position was taken. Following coronary angiogram showed rapid progression of dissection. Therefore, LCX were wired with floppy guidewires and dissection in LCX was stented first with a Tsunami 3.0mmx30mm stent at 10 atm, after which the following angiography revealed restored flow of LCX without residual dissection (Figure 3). And then, LMCA was treated with a 4.0mmx13 mm Bx stent at 9 atm, confined to LMCA without protrusion into LCX or LAD. Final angiography showed well deployed stent in the LMCA and LCX without residual stenosis or dissection. Coronary flow was also restored to TIMI 3 flow (Figure 4, Figure 5). The hospital course was uneventful after stenting. |
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