In a recent study of Lee et al.[4] bail-out stenting for LMCA dissection was performed successfully in a total of 10 patients and there was no mortality reported. In another study of 112.921 procedures,[5] urgent CABG was attempted in 42 patients with main coronary artery disease or dissection. Thirty-one of the patients (75%) were alive at one month. In this study, the emergency CABG was recommended for the patients who develop complications during cardiac catheterization. Gür et al.[6] reported in their study about a catheter-induced RCA dissection treated by emergent off-pump CABG. In another study,[7] LMCA dissections with limited retrograde aortic involvement were successfully managed with stenting of the coronary dissection entry point. Also in this study, the overall incidence of coronary artery-aortic dissections was 0.02%, and surgical intervention was recommended to the dissections extending up the aorta >40 mm from the coronary ostium. In an autopsy study of Curtis et al.[8] it has been hypothesized that an angulated LMCA (acute angle take off) may be a risk factor for a dissection during the angiography.
Copini et al.[3] reported about the potential advantages of intracoronary stenting for catheter-induced coronary dissections in terms of the speed of reperfusion and availability in centers performing diagnostic coronary angiography without surgical back-up on site. We believe this conclusion is valid to a limited extent and the management strategy depends closely to the patients’ clinical status. Although intra-aortic balloon pump support earns some time for surgical intervention, we do not recommend performing diagnostic coronary angiography without surgical back-up on site.
In conclusion, iatrogenic LMCA dissection during selective coronary angiography is a rare but life-threatening complication. Early diagnosis and life-saving management is extremely important.