Iatrogenic Left Main Coronary Artery Dissection With Retrograde Aortic Extension During Complex Percutaneous Coronary Intervention in a Left‐Dominant System: A Case Report

Figures

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  FIGURE 1. Selective left heart catheterisation performed via the radial approach, demonstrating severe calcified stenosis of the mid left anterior descending (LAD) artery with associated mild proximal disease of the left circumflex (LCx) artery. The right coronary artery (RCA) was nondominant and free of significant obstructive disease. These angiographic findings prompted planned percutaneous coronary intervention (PCI) to the LAD artery.

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  FIGURE 2. Guidewire successfully advanced across the lesion, with initial vessel preparation performed using a 2.0 × 10 mm semi‐compliant (SC) balloon.

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  FIGURE 3. Following the onset of chest pain and a drop in blood pressure, vasopressor therapy was initiated. To seal the dissection entry point and prevent further progression, the stent in the LAD was deployed.

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  FIGURE 4. During positioning of a 3.0 × 26 mm DES, severe left main coronary artery dissection was identified, with antegrade extension causing occlusion of the LAD and LCx, and retrograde propagation toward the aortic root and ascending aorta.

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  FIGURE 5. A 4.0 × 18 mm DES was implanted to cover the left main coronary artery. As flow in the LCx was reduced, a coronary guidewire was advanced into the LCx.

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  FIGURE 6. POT and post‐dilation performed using a 4.5 × 10 mm NC balloon in the LM, and a 3.5 × 10 mm NC balloon in the LAD artery.

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  FIGURE 7. KBI performed to restore LCx flow using a 3.5 × 10 mm NC balloon in the LAD and a 2.5 × 10 mm SC balloon in the LCx, followed by repeat POT.

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  FIGURE 8. Final results showed restored coronary perfusion with effective sealing of the dissection.

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  FIGURE 9. CT angiogram of the aorta confirmed no retrograde extension of the dissection into the ascending aorta, with the dissection fully contained.