CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
AFRICA
e7
Discussion
Catheter-induced LMCA dissection is a rare complication of
diagnostic coronary angiography, but has a very high mortality
rate if not treated. In previous reports, authors have defined
this situation as the ‘nemesis of interventional cardiologists’.
1
The incidence of catheter-induced LMCA dissection has been
reported as less than 0.1% in several articles,
2,3
but more than 10
times higher in patients with left main coronary artery stenosis
(1.05%).
4
Vigorous contrast injections while the catheter is not co-axial,
not using a soft-tipped catheter, deep intubation, and careless
catheter manipulation can all cause LMCA dissection. After
LMCA stenosis, patients with hypertension, Marfan syndrome,
congenitally unicuspid and bicuspid aortic valves, and cystic
medial necrosis have been reported to have a higher risk factor
for dissection.
5
Conclusion
Traditionally, CABG has been the treatment of choice, but
it delays the time until normal flow is restored. Good long-
term survival has been reported for percutaneous coronary
intervention in patients with LMCA dissection. No cardiac
deaths have occurred during a mean follow up of 30 months,
with 84.6% angiographic success. Therefore, particularly in PCI
centres, it should be considered as the first treatment option.
2
References
1.
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a case report and review of the literature.
Z Kardiol
2002;
91
: 840–845.
2.
Cheng CI, Wu CJ, Hsieh YK, Chen YH, Chen CJ, Chen SM,
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Percutaneous coronary intervention for iatrogenic left main coronary
artery dissection.
Int J Cardiol
2008;
126
: 177–182.
3.
Dunning DW, Kahn JK, Hawkins ET, O’ Neill WW. Iatrogenic coronary
artery dissections extending into and involving the aortic root.
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Cardiovasc Intervent
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4.
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: 76–78.
5.
Awadalla H, Sabet S, El SA, Rosales O, Smalling R. Catheter-induced
left main dissection incidence, predisposition and therapeutic strategies
experience from two sides of the hemisphere.
J Invasive Cardiol
2005;
17
: 233–236.
