Tokumasu Yoshinori, Obata Jyun-Ei, Oka Satoshi, Hoshina Katsuomi, Watanabe Kazunori, Nakamura Jun, Abe Makoto, Watanabe Akinori
Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan.
Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
J Cardiol Cases. 2021 Jan 30;24(2):64-67. doi: 10.1016/j.jccase.2021.01.003. eCollection 2021 Aug.
Iatrogenic left main coronary artery (LMCA) dissection is a complication inadvertently caused by the interventional cardiologist and can have significant consequences. A 38-year-old man presented to hospital with non-ST-elevation myocardial infarction. Coronary angiography (CAG) revealed an obstructed proximal left circumflex artery (LCx) that was successfully treated with revascularization using a drug-eluting stent (DES). However, CAG after recanalization of the LCx demonstrated a spiral dissection of the left coronary artery from the mid-LMCA to the left anterior descending (LAD) artery and LCx. The dissection was classified as National Heart, Lung and Blood Institute type D in LAD and type F in LCx. Immediate exclusion stenting of the dissection flap by another DES and thrombolysis in myocardial infarction 3 flow were achieved in the LAD and LCx. The patient achieved hemodynamic stability with improvement in symptoms, despite residual dissection in the LAD. We, therefore, preferred careful observation over revascularization. The false lumen remained visible with a double-barrel appearance in the LAD on 6-month follow-up CAG, which disappeared at the 2-year follow-up. We report a rare case of a large double-barrel dissection that spontaneously occluded over time without any aggressive interventions. < Iatrogenic left main coronary artery (LMCA) dissection is a rare but potentially life-threatening complication, with the associated risk of serious outcomes. Immediately after suffering a LMCA dissection, treatment strategies (conservative therapy, percutaneous coronary intervention, or coronary bypass grafting etc.) should be determined according to patient's symptoms and hemodynamic status. However, treatment strategies for chronic LMCA dissection are uncertain. Our case indicates that conservative therapy appears to be a potential option for the treatment of chronic asymptomatic and hemodynamically stable LMCA dissection.>.
医源性左冠状动脉主干（LMCA）夹层是介入心脏病专家无意中造成的一种并发症，可能会产生严重后果。一名38岁男性因非ST段抬高型心肌梗死入院。冠状动脉造影（CAG）显示左回旋支动脉（LCx）近端阻塞，使用药物洗脱支架（DES）进行血运重建成功治疗。然而，LCx再通后的CAG显示左冠状动脉从LMCA中段至左前降支（LAD）动脉和LCx呈螺旋状夹层。该夹层在LAD中被分类为美国国立心肺血液研究所D型，在LCx中为F型。通过另一枚DES立即对夹层瓣进行封堵支架置入，并在LAD和LCx中实现心肌梗死3级血流的溶栓。尽管LAD仍有残余夹层，但患者实现了血流动力学稳定，症状改善。因此，我们倾向于仔细观察而非血运重建。在6个月的随访CAG中，LAD中假腔仍可见双腔外观，在2年随访时消失。我们报告了一例罕见的大型双腔夹层病例，该夹层随时间自发闭塞，未进行任何积极干预。<医源性左冠状动脉主干（LMCA）夹层是一种罕见但可能危及生命的并发症，伴有严重后果的相关风险。LMCA夹层发生后，应立即根据患者症状和血流动力学状态确定治疗策略（保守治疗、经皮冠状动脉介入治疗或冠状动脉旁路移植术等）。然而，慢性LMCA夹层的治疗策略尚不确定。我们的病例表明，保守治疗似乎是治疗慢性无症状且血流动力学稳定的LMCA夹层的一种潜在选择。>
