Iatrogenic Left Main Coronary Artery Dissection: Epidemiology, Treatment and Medium-term Outcome – A Monocentric Study

Background: Left main (LM) coronary artery dissection induced by Catheter 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.

Study Objectives: The objective of this study is to investigate the occurrence,, 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 thoroughly investigated, and clinical follow-up was obtained in all patients who experienced iatrogenic LM dissection.

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. There was no specific causative catheter found. Obstructive LM coronary artery dissection occurred in 5 patients, with 70% involving the distal LM. In 11/20 patients, hemodynamic status was immediately compromised. The LM PCI strategy included provisional stenting of the side branch following LM and main vessel stenting with final kissing inflation. Angiographic success was achieved in 18/20 patients, and the in-hospital outcome was free of events or re-intervention in these patients. PCI was unable to restore blood flow in two patients who died during the procedure. 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 overall incidence of less than one in 1000 coronary procedures, but a mortality rate of 10% in this study. Emergency PCI with DES is a safe and effective treatment with a favourable long-term outcome.