Percutaneous coronary intervention for iatrogenic left main coronary artery dissection.
Int J Cardiol
; 126(2): 177-82, 2008 May 23.
Article
em En
| MEDLINE
| ID: mdl-17490760
ABSTRACT
BACKGROUND:
Although catheter-induced left main coronary artery (LMCA) dissection is a rare complication of coronary catheterization, it is a common cause of periprocedural mortality. Emergent coronary artery bypass surgery (CABG) is the mainstay for managing this acute complication. However, hemodynamic deterioration may progress while patients await emergent CABG; consequently, a high postoperative mortality rate has been reported. Although the number of cases was small, prompt bail-out stenting for iatrogenic LMCA dissection had reportedly reversed this complication with favorable clinical outcomes.METHODS:
This study included 13 cases of attempted stenting for iatrogenic LMCA dissection classified as grades C-F based on the National Heart, Lung and Blood Institute (NHLBI) classification system. Angiographic success, in-hospital mortality and long-term outcomes were analyzed.RESULTS:
The incidence of iatrogenic LM dissection was 0.071%. Most of the patients were initially asymptomatic. Angiographic success was achieved in 11 of 13 patients (84.6%). Including one patient who underwent emergent CABG after a failed wiring attempt, two mortalities occurred in this series. Mean follow-up duration of the ten patients discharged was 30.1+/-11.8 months, and no cardiac deaths occurred. Follow-up angiogram of eight patients with a mean interval of 5.2+/-2.3 months after initial event demonstrated restenosis in three patients occurring either at the ostiums of the left anterior descending artery or left circumflex artery. Revascularization was performed on two patients.CONCLUSIONS:
Successful bail-out stenting resulted in good long-term survival and should be considered for initial management of iatrogenic LMCA dissection.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Aneurisma Coronário
/
Angioplastia Coronária com Balão
/
Doença Iatrogênica
/
Dissecção Aórtica
Tipo de estudo:
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2008
Tipo de documento:
Article