Iatrogenic Left Main Coronary Artery Research Articles

Transesophageal echocardiography: a tool for intraoperative assessment of coronary blood flow

Transesophageal echocardiography (TEE) has become an indispensable part of cardiac surgery, but its potential for assessing coronary anatomy and blood flow remains underutilised. This case report presents a case of acute iatrogenic left main coronary artery obstruction following re-operative aortic valve replacement that was promptly diagnosed by intraoperative TEE and managed successfully by Bentall operation. We also emphasise the technique of TEE for coronary evaluation, its caveats and its clinical application during cardiac surgery.

Delayed percutaneous coronary intervention for an extensive iatrogenic left main coronary artery dissection: a case report

BackgroundIatrogenic left main coronary artery dissection is a rare but serious complication that can occur both during diagnostic coronary angiography and percutaneous coronary intervention. Early diagnosis and choice of optimal management are of crucial importance for patient’s outcome while representing a challenge for clinicians.Case presentationWe present a case of iatrogenic left main coronary artery dissection occurring during diagnostic coronary angiography in a 53-year-old Greek woman with a history of coronary artery bypass grafting. Although dissection was greatly extending to mid left anterior descending artery, delayed percutaneous coronary intervention was successfully performed by carefully wiring the true lumen.ConclusionsDelayed percutaneous coronary intervention, performed 25 days following the index event, proved to be a feasible and effective strategy for treating a widely extended left main coronary artery iatrogenic dissection.

Iatrogenic Left Main Coronary Artery Dissection During Non-Left Main Intervention: A Case Series

Iatrogenic left main coronary artery (LMCA) dissection is a rare complication of percutaneous coronary intervention (PCI), it is mainly attributed to the catheter-based manipulation during engagement of Ostia or during the intervention. LMCA dissections are very dynamic ranging from a small, stable, and localized tear to extensive dissection obstructing coronary branches and cardiac arrest. Without prompt intervention, it often is a fatal complication. In this case series, we report three cases of LMCA dissection and their management with intravascular ultrasound-guided PCI.

Rare Iatrogenic left main coronary artery dissection during angiography and its management: mind the catheter tip.

Rare Iatrogenic left main coronary artery dissection during angiography and its management: mind the catheter tip.

Successful Percutaneous Management of Iatrogenic Left Main Coronary Artery and Ascending Aorta Dissection

Iatrogenic left main coronary artery and aortic root dissection is a rare but life-threatening complication of percutaneous coronary intervention. This is a case where this complication was induced by catheter manipulation. Prompt percutaneous closure of the dissection point of entry was effective in managing this complication. (Level of Difficulty: Advanced.)

Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation

Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation

TCTAP C-072 The Bail Out Case of Iatrogenic Left Main Coronary Artery Dissection - What Should We Do?

TCTAP C-072 The Bail Out Case of Iatrogenic Left Main Coronary Artery Dissection - What Should We Do?

Iatrogenic Left Main Coronary Artery Dissection Treated with Bare Metal Stents: A Case with Twelve Years Angiographic Follow-up

Complications during the course of Percutaneous Coronary Interventions (PCI) are common. One of the complications is iatrogenic Left Main Coronary Artery (LMCA) dissection, which is considered as lethal in nature and prevails in around 0.07% PCI cases. Timely diagnosis and immediate revascularisation is mandatory to manage LMCA dissection in order to avoid worsening of patient’s haemodynamic condition and to re-establish antegrade coronary blood flow. Here, the author report a case of catheter-induced iatrogenic LMCA dissection developed during stenting of a lesion in Left Anterior Descending (LAD) coronary artery of a 32-year-old male patient. The patient was managed by implantation of two Matrix (Sahajanand Medical Technologies, Pvt., Ltd., Surat, India) Bare Metal Stents (BMS) using double barrel technique to treat the dissection in left main coronary bifurcation. The patient was regularly followed-up and even after 12 years of the index procedure, the angiographic data revealed good patency of stents in LMCA without any major cardiac events.

Iatrogenic Left Main Coronary Artery Dissection Treated with Bare Metal Stents: A Case with Twelve Years Angiographic Follow-up

Complications during the course of Percutaneous Coronary Interventions (PCI) are common. One of the complications is iatrogenic Left Main Coronary Artery (LMCA) dissection, which is considered as lethal in nature and prevails in around 0.07% PCI cases. Timely diagnosis and immediate revascularisation is mandatory to manage LMCA dissection in order to avoid worsening of patient’s haemodynamic condition and to re-establish antegrade coronary blood flow. Here, authors report a case of catheter-induced iatrogenic LMCA dissection developed during stenting of a lesion in Left Anterior Descending (LAD) coronary artery of a 32-year-old male patient. The patient was managed by implantation of two Matrix (Sahajanand Medical Technologies, Pvt., Ltd., Surat, India) Bare Metal Stents (BMS) using double barrel technique to treat the dissection in left main coronary bifurcation. The patient was regularly followed-up and even after 12 years of the index procedure, the angiographic data revealed good patency of stents in LMCA without any major cardiac events.

Iatrogenic Left Main Coronary Artery Dissection Treated with Bare Metal Stents: A Case with Twelve Years Angiographic Follow-up

Complications during the course of Percutaneous Coronary Interventions (PCI) are common. One of the complications is iatrogenic Left Main Coronary Artery (LMCA) dissection, which is considered as lethal in nature and prevails in around 0.07% PCI cases. Timely diagnosis and immediate revascularisation is mandatory to manage LMCA dissection in order to avoid worsening of patient’s haemodynamic condition and to re-establish antegrade coronary blood flow. Here, authors report a case of catheter-induced iatrogenic LMCA dissection developed during stenting of a lesion in Left Anterior Descending (LAD) coronary artery of a 32-year-old male patient. The patient was managed by implantation of two Matrix (Sahajanand Medical Technologies, Pvt., Ltd., Surat, India) Bare Metal Stents (BMS) using double barrel technique to treat the dissection in left main coronary bifurcation. The patient was regularly followed-up and even after 12 years of the index procedure, the angiographic data revealed good patency of stents in LMCA without any major cardiac events.

Management of iatrogenic left main coronary artery dissection in a center without onsite cardiac surgery back up

Catheter-related iatrogenic left main coronary artery dissection is an extremely rare complication that can cause fatal outcomes if not recognized and treated early. In the current approach, conservative follow-up, bailout stenting with percutaneous intervention and bypass surgery treatment options are available. However, in some centers, coronary angiography and interventional applications are performed without surgical support. Management of such rare but important complications becomes more complex in these centers. In this experience, we wanted to share after her approval, how we managed catheter-induced iatrogenic left main coronary artery dissection in a 72-year-old female patient with bailout stenting and conservative approach in a center without surgical back up.

A Successfully Treated Iatrogenic Left Main Coronary Artery Dissection: A Catastrophic Complication

A Successfully Treated Iatrogenic Left Main Coronary Artery Dissection: A Catastrophic Complication

TCTAP C-115 Successful Bailout of Iatrogenic Left Main Coronary Artery Thrombosis by "Pushing Method" with an Extension Catheter

TCTAP C-115 Successful Bailout of Iatrogenic Left Main Coronary Artery Thrombosis by "Pushing Method" with an Extension Catheter

Iatrogenic Left Main Coronary Artery Dissection in a Non-Primary Percutaneous Intervention Setup without On-Site Cardiac Surgery Backup

Iatrogenic Left Main Coronary Artery Dissection in a Non-Primary Percutaneous Intervention Setup without On-Site Cardiac Surgery Backup

TCTAP C-153 Iatrogenic Left Main Coronary Artery Dissection

TCTAP C-153 Iatrogenic Left Main Coronary Artery Dissection

Iatrogenic left main coronary artery dissection: mind the catheter tip

Iatrogenic left main coronary artery dissection is a rare but potentially life-threatening complication of invasive coronary procedures, which ­requires prompt recognition and management. We present cases of two ­patients with type C guiding catheter-induced left main coronary artery dissections that were successfully tackled with bail-out stent angioplasty. The aetiology, recognition, management and prevention of this complication is discussed.

Rescue extracorporeal membrane oxygenation for refractory cardiogenic shock.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used for bridge-to-recovery, bridge-to-decision or bridge to ventricular assist device (VAD) implantation or heart transplantation in patients with cardiogenic shock (CS). We report a case of iatrogenic left main coronary artery (LMCA) dissection and secondary cardiogenic shock in which mechanical cardiopulmonary support with portable ECMO was used to rescue the patient after urgent surgical revascularization. Extracorporeal membrane oxygenation has the potential to improve tissue perfusion without the adverse consequences of medical therapies, consisting primarily of inotropic agents and vasopressors, such as increased myocardial oxygen demand and ischemia, arrhythmogenicity and reduction of tissue microcirculation, creating the opportunity to reduce the high mortality rates currently associated with conventionally managed patients in CS.

Conservative treatment of iatrogenic left main coronary artery dissection: report of two cases.

Revascularization treatment is mostly recommended for iatrogenic left main coronary artery dissection because of potential for catastrophic sequel, even in case of initial TIMI 3 flow and hemodynamic stability. However, conservative treatment seems to be feasible in asymptomatic and hemodinamically stable patient with low-grade dissection. We report two cases of iatrogenic left main coronary dissection managed conservatively.

Immediate bail-out TAP-stenting for the treatment of iatrogenic aortocoronary dissection involving left main bifurcation.

Iatrogenic aortocoronary dissection is a rare but potentially disastrous complication of percutaneous coronary intervention. The left main dissection extending into distal bifurcation involving both the left anterior descending and left circumflex is a complex and vital complication, which is classified as Eshtehardi Type II dissection. We presented a case of iatrogenic left main coronary artery dissection with upcoming closure of both major branches, which was successfully managed by immediate bail-out TAP-stenting. The 77-year-old patient was discharged without any complication, and 1-year follow-up indicated stent patency and favorable clinical result. Immediate bail-out stenting is a feasible and reasonable initial management for this lethal complication.

Catheter induced left main coronary artery stenosis: A rare complication of percutaneous coronary intervention

Introduction: Iatrogenic left main coronary artery lesion following percutaneous coronary intervention (PCI) is a rare complication. Bashour et al. first reported this complication more than twenty­three years ago. Fortunately, this was one of only a handful of cases reported in literature, in spite of the thousands of procedures performed every year. Case Series: We are reporting two cases of catheter induced left main coronary artery stenosis. One of the cases involved PCI to left anterior descending artery (LAD) and the 2nd to the left circumflex artery (LCX). Neither cases revealed significant plaque burden in the left main coronary artery (LMCA). The patients in both cases returned within three months with symptoms of angina, and were found to have critical left main disease, presumably induced by guide catheters. One patient underwent coronary artery bypass graft (CABG) and other had successful ostial left main PCI. Conclusion: Catheter induced left main coronary artery disease is a rare but serious complication of PCI, and should always be considered in any patient that returns with chest pain following PCI. Particular attention should be paid to catheter and device manipulation during the procedure to avoid this potentially calamitous complication.