Iatrogenic propagation of left main coronary artery dissection during diagnostic coronary angiography: A case report.

RATIONALE

Iatrogenic dissection of the left main coronary artery (LMCA) extending to the left anterior descending (LAD) and left circumflex arteries is a very rare but catastrophic complication during coronary intervention. Prompt diagnosis and appropriate management are essential for improving patient outcomes.

PATIENT CONCERNS

We report the case of a 78-year-old male with a past medical history of hypertension and previous myocardial infarction who presented to the emergency department with progressively worsening angina over 2 weeks.

DIAGNOSES

During coronary angiography, LMCA dissection occurred due to catheter manipulation. The dissection extended to both the LAD and left circumflex arteries, causing hemodynamic instability.

INTERVENTIONS

Using a provisional stenting strategy, the dissection was successfully treated with percutaneous transluminal coronary angioplasty and stent placement from the LMCA to the proximal and mid-LAD. Intravascular ultrasound-guided optimization confirmed appropriate stent expansion and apposition after the proximal optimization technique.

OUTCOMES

The patient's chest pain resolved postprocedure, and he remained hemodynamically stable during a 6-month follow-up with patent stents confirmed on check angiogram.

LESSONS

This case highlights the importance of preventing, recognizing, and promptly managing iatrogenic LMCA dissection to prevent fatal outcomes. Intravascular ultrasound-guided optimization plays a crucial role in ensuring optimal stent placement in these high-risk emergency interventions.