Iatrogenic Left Main Coronary Artery Dissection: Epidemiology, Treatment and Medium-term Outcome – A Monocentric Study

Background: Catheter-induced left main (LM) coronary artery dissection is uncommon, yet it necessitates rapid care. In this case, the outcomes of an emergency percutaneous intervention (PCI) using DES to restore flow in the left coronary artery remain unknown.

The purpose of this study is to look at the occurrence, clinical and angiographic aspects, as well as the long-term effects of iatrogenic LM dissection. Emergency PCI with DES was the technique for coronary revascularization.

Methods: A review of all 24,995 coronary procedures conducted in our institution (which includes two catheter-laboratories) over an eight-year period (1 april 2009- 1 april 2017). Cases of iatrogenic LM dissection were discovered and extensively evaluated, and all patients who underwent iatrogenic LM dissection received clinical follow-up.

Catheter-induced LM dissection occurred in 20 patients, accounting for 0.08 percent of total procedures: 16/8,019 PCI (0.2 percent) and 4/16,976 diagnostic angiograms (0.02 percent ).

In 7/20 cases, there was significant LM stenosis. There was no evidence of a specific causal cause. 5 individuals had obstructive LM coronary artery dissection, with 70% impacting the distal LM. Hemodynamic state was promptly disrupted in 11/20 individuals. Following the LM, the PCI technique included provisional stenting of the side branch and main vascular stenting with final kissing inflation. Angiographic success was obtained in 18/20 individuals, and the in-hospital prognosis in these patients was free of events or re-intervention. In two patients who died during the treatment, PCI was unable to restore blood flow. During the follow-up period, two patients had repeat revascularization (1 CABG, 1 re-PCI), but no other adverse events occurred.

Catheter-induced LM coronary artery dissection is an uncommon complication with an overall incidence of fewer than one in 1000 coronary surgeries but a death rate of 10% in this study. Emergency PCI with DES is a safe and effective treatment with a good long-term prognosis.

Author(S) Details

M. A. Bouraghda
CHU Frantz Fanon, Blida, Algeria.

M. A. Bouzid
CHU Frantz Fanon, Blida, Algeria.

S. Benghezal
CHU Frantz Fanon, Blida, Algeria.

N. Megherbi
CHU Frantz Fanon, Blida, Algeria.

M. Chettibi
CHU Frantz Fanon, Blida, Algeria.

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