Management of LCA-LM dissection.

1
Management of LCA-LM dissection.

• Bogdan Gorycki
• American Heart of Poland
• Ustron, Poland

2
Case report

• 42 years old female
• Effort angina, diseaness, syncope
• Hypertension
• Diabetes mellitus
• Hypothyreosis
• Overweigth (body weight 120 kg)

3
Non-invasive tests

• UKG LV function normal
• EKG ST/T changes at rest
• Spiral CT hypoplasia of left vertebral artery,
  no significant lesion in carotid arteries, right
  vertebral artery ostial lesion.

4
Further diagnosis

• The patient scheduled for coronary artery and
  carotid/vertebral angiogragphy

5
LCA RAO30, Caudal 15
6
LCA LAO 55, Cranial 22
Dissection LM/Cx
Time 2250
Dissection LAD/D1
7
Fast diagnosis and problem solving

• DiagnosisSpiral dissection of LM, LM
  bifurcation, proximal Cx and proximal LAD/D1
• Management-stop diagnostic procedure-immediate
  proceeding to LM stenting -6F JL Guiding
  catheter -two soft wires (BMW, Guidant)

8
Fast wiring of LAD and Cx
Time 2255
Aortic pressure90/50 mmHg HR 110/minECG ST
elevation. Chest pain treated with analgetics.
9
Direct stenting LM/LAD
Time 2300
Time 2257
Aortic pressure80/40 mmHg HR120/min.
Aortic pressure 100/60 mmHg HR 90/min.
After LM/LAD stenting
BX Velocity 3.5x23mm18 atm., 15 sec.
10
Cx stenting
Stent Bx Sonic 3.5x13mm in position.
Re-wiring Cx wire and predilatation Ostium Cx
with2.5 balloon
11
Final result
Time 2316
LCARAO30, Caud22
LCA LAO52, Caud 14
12
One-stage VA stenting
Direct stenting BX Velocity 4.0x13mm
Ostial stenosis (90) of right VA artery
13
Conclusions

• LM stenting is life saving procedure in patients
  with LM dissection which occurs during diagnostic
  or therapeutic percutaneous coronary
  intervention.
• The procedure should be included to routine
  training and practice.