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Abstract
Left Internal Mammary Artery (LIMA) dissection is a potential catastrophic complication of percutaneous coronary intervention (PCI) rarely observed in hypertensive patients. There are very few reports but the paucity of data regarding the incidence capture the imagination more than other coronary dissections. Additionally, for the management of this iatrogenic complication there are no evidence-based guidelines to assist the operator. We present a case of two diagnostic catheter-induced dissections of LIMA successfully resolved with long multiple stenting, and review the existing literature. In our opinion, these case reports describe a very rare condition in hypertensive patients with some practical tips on how to avoid them, whereas there are very few published data. Moreover, we have shown that stenting has been used to solve a potentially deadly procedural complication, in a basal extremely serious clinical situation.
Highlights
A hypertensive and obese 58-year-old male with acute coronary syndrome without ST elevation, was admitted to our department
The Left Internal Mammary Artery (LIMA) was cannulated with the same JR 3.5 diagnostic catheter
The LIMA graft has shown superior patency rates compared to the saphenous vein graft (SVG), as reported by copious medical literature [1]
Summary
Native coronary angiography was performed by left radial access with 5Fr JL 3.5 and JR 3.5 diagnostic catheter (both Medtronic). The first injection showed a sub-occlusive lesion of distal segment of the graft (Figure 1A). Angiography was immediately repeated and it revealed total occlusion of proximal segment of the LIMA with TIMI (thrombosis in myocardial infarction) 0 flow (Figure 1B).
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