| Left
main dissection with guiding catheter |
| Interventional
cardiologist |
Jorge Musetti-Daniel Fiandra |
| Center |
Instituto Nacional de Cirugía Cardíaca
Montevideo - Uruguay |
| History |
Male.Smoker,no other cardiovascular risk
factor. Unstable angina since 4 months. Angiography showed LAD disease.
Intended PTCA with direct stenting. The left main dissected by the guiding catheter
(Cordis JL4, 6F). Severe drop of the pressure and chest pain. |
| Strategy |
Intention to cross the dissection with wire
followe by direct stenting. Urgent CABG |
| Procedure |
A BMW ACS wire crossed the dissection, which
was stented with a Guidant Tetra 3.0 x 18 stent. The left main stenting occurred fast, and
the patient was stable. The procedure was continued with a balloon in the difusely
diseased LAD, and by placement of a Bx Velocity 2.5 x 18 hepacoat stent in the
proximal LAD. Uneventful clinical course in the cardiac
unit and hospital discharge 4 days later. Clinical surveilance and new angiogram in
45 days |
| Comments |
The disecction of the left main is a real
nigthmare. Fast crossing of the dissection and immediate stenting is probably the
key for a good outcome of these patients. |
