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Catheter Induced Left Main Coronary Artery Dissection: Incidence, Management and Medium-term Outcome �?? A Study of Contemporary Practice

Bouraghda MA*, Bouzid MA,Benghezal S, Nedjar R and Chettibi M

Background: Catheter-induced left main (LM) coronary artery dissection is rare but requires immediate intervention. In this situation, the results of emergency percutaneous intervention (PCI) using DES to restore the flow in the left coronary artery are poorly known.

Aims of the Study: To examine the incidence, clinical and angiographic features as well as the longer-term outcomes of iatrogenic LM dissection. The strategy for coronary revascularization was emergency PCI using DES.

Methods: A study of all 24,995 coronary procedures performed in our institution (comprising 2 catheter-laboratories) during eight years in succession (1 April 2009- 1 April 2017). Cases of iatrogenic LM dissection were identified and studied in detail and clinical follow-up was obtained in all patients in whom iatrogenic LM dissection occurred.

Results: Catheter-induced dissection of the LM occurred in 20 patients, representing 0.08 % of the all procedures: 16/8,019 PCI (0.2%) and 4/16,976 diagnostic angiograms (0.02%). Significant LM stenosis was present in 7/20 patients. No specific causal catheter was identified. LM coronary artery dissection was obstructive in 5 patients and involved the distal LM in 70%. Hemodynamic status was immediately impaired in 11/20 patients. The strategy for LM PCI was provisional stenting of the side branch after LM and main vessel stenting with final kissing inflation. Angiographic success was obtained in 18/20 and in these patients in-hospital outcome was free of events or re-intervention. PCI failed to restore blood flow in 2 patients who died during PCI attempt. During follow-up repeat revascularization was required in 2 patients (1 CABG 1 re-PCI) but there were no other adverse events.

Conclusion: Catheter-induced LM coronary artery dissection is a rare complication with an incidence of less than 1 in 1000 coronary procedures overall, but with a mortality rate in this study of 10%. Emergency PCI with DES is an effective and appropriate treatment associated with a favourable midterm outcome.