A catastrophic nightmare of the interventional cardiologist: Iatrogenic left main artery dissection and longitudinal stent deformation

Complicated coronary artery dissection in which a guidewire was pushed out from the true lumen to the false lumen behind calcified plaque

Coronary artery dissection is a common complication in percutaneous coronary intervention (PCI). The bailout procedure from coronary artery dissection is relatively simple if a guidewire remains within the true lumen. However, if the guidewire migrates into a dissection cavity separated by a calcified plaque, the bailout procedure is more difficult even for experienced interventional cardiologists. In this case report, we provide a bailout procedure for complicated coronary artery dissection, in which the guidewire was pushed out from the true lumen to the false lumen behind calcified plaque. The knowledge of guidewire bias and intravascular ultrasound-guided PCI was useful and the technique to strengthen the back-up support was necessary for the successful bailout.

Learning objective

Guidewire migration into the false lumen behind a calcified plaque is a rare complication, but the knowledge of a bailout method using guidewire bias and intravascular ultrasound is important.

Longitudinal Stent Deformation at the Proximal Segment of the Left Main Coronary Artery Caused by a Stuck OCT Catheter: Case Report and Review of Literature

It has been rarely reported that a stuck optical coherence tomography (OCT) catheter can lead to longitudinal stent deformation (LSD). This complication can result in incomplete stent apposition and dissection after stent implantation. In this study, we present a case where a bailout stent was implanted in the distal segment of the left anterior descending artery (LAD) after longitudinal stent deformation caused by a stuck OCT catheter. This approach was taken to prevent acute stent thrombosis, subacute stent thrombosis, in-stent restenosis (ISR), and death. The patients were followed up for one year, and no adverse events were observed.

Spontaneous Coronary Artery Dissection Masquerading as Coronary Artery Stenosis in a Young Patient

BACKGROUND Spontaneous coronary artery dissection (SCAD) is primarily found in females. SCAD can have many precipitating factors such as exercise, trauma, pregnancy, drugs, and connective tissue disease. Prognosis is poor for left main stem, left anterior descending (LAD) artery, and multivessel involvement, especially for females. CASE REPORT We present a case of young African American male with sickle cell disease who presented with chest pain associated with shortness of breath. He was found to have non-ST elevation myocardial infarction (NSTEMI). He was diagnosed with SCAD during catheterization with the help of intravascular ultrasound imaging. Three drug-eluting stents were placed to cover the proximal LAD vessel along its whole length until resolution of the lesion. The patients' hospital course was complicated by an additional finding of left ventricular thrombus, possibly a complication of NSTEMI, which was treated with anticoagulation to complete resolution. CONCLUSIONS SCAD is fatal, it can proceed to cause myocardial infarction as in this particular patient's case, and sudden death if not recognized early. It can be missed on angiography alone; further intracoronary imaging such as intravascular ultrasound and optical computed tomography should be used to confirm the diagnosis of SCAD so that early and appropriate treatment can ensue.