Bail-out stenting for left main coronary artery dissection during catheter-based procedure: acute and long-term results

Lee, Se Whan; Lee, Seung Whan; Hong, Myeong Ki; Kim, Young Hak; Lee, Cheol Whan; Han, Ki Hoon; Song, Jong Min; Kang, Duk Hyun; Song, Jae Kwan; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung

Abstract

BACKGROUND: The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain. We retrospectively analyzed the acute and long-term results of bail-out stenting for LMCA dissection.
METHODS
In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome. We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during catheter-based procedure in 10 patients.
RESULTS
Initially, there was no significant stenosis of LMCA segment in these patients. Catheter-induced dissection occurred in 8 patients (during diagnostic angiography in 3 patients and guiding catheter manipulation in 5 patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In 4 patients, hypotension developed and intra-aortic balloon pump was placed during procedure. Stents were successfully deployed in all patients. There was no in-hospital mortality. Six-month angiographic follow-up was performed in 8 patients. Angiographic restenosis (diameter stenosis 50%) was not observed in all patients at follow-up study. During a mean follow-up of 31 +/- 25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization).
CONCLUSION
Bail-out LMCA stenting is technically feasible, and showed good acute and long-term results in a small series of patients.