What is the clinical evidence from this study?

Study design: Case Report. Population: Iatrogenic coronary artery dissection (n=1). Intervention: Emergent stenting.

May 10, 2026Open Access

From bad to worse: a case report of bilateral iatrogenic coronary dissection complicated with cardiac arrest

Key Result

Emergent stenting successfully sealed simultaneous iatrogenic dissections of both the left main and right coronary arteries in a 40-year-old woman following cardiac arrest.

Key Points

To discuss a rare case of bilateral iatrogenic coronary artery dissection leading to cardiac arrest.
Described the case of a 40-year-old woman with non-ST-elevation acute coronary syndrome.
Performed initial angiography and subsequent angiograms to identify dissections.
Administered urgent stenting as the primary intervention for dissection management.
Identified simultaneous dissections in both the left main coronary artery and right coronary artery.
Successfully performed urgent stenting to seal dissection planes in both vessels.
Patient recovered and was discharged four days post-procedure.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 40-year-old woman with no medical history presenting with non-ST-elevation acute coronary syndrome.

Intervention

Emergent stenting of both the left main coronary artery (LMCA) and right coronary artery (RCA)

Outcome

Successful sealing of dissection planes and patient recovery

Emergent stenting is an effective life-saving treatment for the extremely rare and life-threatening complication of simultaneous bilateral iatrogenic coronary artery dissection.

Abstract

Abstract Background Iatrogenic coronary artery dissection is a rare but life-threatening complication, occurring in fewer than 0.1% of coronary procedures. It is typically precipitated by aggressive or deep intubation with large catheters. While most dissections are unilateral, bilateral occurrences are exceptionally rare and often suggest underlying “vulnerable” vessel conditions, such as fibromuscular dysplasia. Case Summary A 40-year-old woman with no medical history presented with non-ST-elevation acute coronary syndrome. Initial angiography of the right coronary artery (RCA) and left main coronary artery (LMCA) showed no obstructive lesions. Post-procedure, the patient developed recurrent chest pain and circumferential ST-segment elevation, followed by ventricular fibrillation that required electrical cardioversion. A second angiogram revealed simultaneous dissections of both the LMCA and RCA. Emergent stenting was successfully performed to seal the dissection planes in both vessels. An extensive autoimmune and systemic vascular workup was negative. The patient recovered well and was discharged four days later. Discussion LMCA dissections carry a high mortality risk because they jeopardize a vast territory of the myocardium. In this case, the simultaneous involvement of both the RCA and LMCA represents an extreme clinical challenge. Management must be immediate; urgent stenting is the gold standard to prevent total vessel occlusion, myocardial infarction, and irreversible cardiac damage.