Case 127: PCI Manual - Left main dissection

A patient presented with inferior STEMI. He had occlusion of the mid right coronary artery that was successfully recanalized. He also had a severe lesion in a highly tortuous circumflex coronary artery. The following day he was referred for staged revascularization of the proximal circumflex lesion. Wiring was very challenging due to tortuosity. A Sion black and Suoh 03 guidewire failed to advance into the circumflex and kept prolapsing into the LAD, even after using a Caravel microcatheter. Using a Venture microcatheter a Sion blue guidewire was advanced into the circumflex. Balloon and stent delivery was also challenging. During stent delivery attempts the patient became hypotensive and developed ST segment elevation due to left main dissection. A 3.0x23 mm DES was deployed from the left main into the circumflex restoring antegrade flow with resolution of the ST segment elevation and hypotension. A nice final result was achieved after optimization using IVUS. The patient had an uneventful recovery.

[@cagozdol]

Great case..thanx for sharing..I think one of the reasons for dissection is non-coaxial position of guide-cath (other than extensive manuplation)

[@shangz0216]

Thanks for the educative case sharing.

[@0xnlli]

Good job Dr

[@mohammadjaber6387]

Many thanks

[@Emrelemeliyim]

Thanks a lot

[@micger]

Did you open the struts to LAD?

[@ahmedsabbar9049]

❤❤❤

[@jaroslawsek4554]

It's a pity to dont's see an direkt image of Dissection ... well done

[@PF66]

Did you open the struts into the LAD ?

[@Batette]

Left atrial branch is missing now, right?

[@BuddDwyer]

Had a similar case today but involving the LAD

[@doctorcardio3886]

Do you think femoral approach would have made wiring easier?
also,lcx lesion looks moderate to me.

[@igor____]

👍

[@micger]

did you do kissing balloon? I believe Goran Stankovic would..