Iatrogenic Aorto-Coronary Dissection Successfully Treated With IVUS Guided Unprotected Left Main Stenting: Case Report and Review of Literature

A 52-year-old male underwent cardiac catheterization for abnormal stress test. Trans-radial coronary angiography revealed a severe proximal left anterior descending artery (LAD) lesion. LAD angioplasty was performed with two drug-eluting stents. This resulted in dissection of the proximal LAD, the circumflex artery and the left main coronary artery (LMCA) extending back into the coronary sinus. A diagnosis of type 3 coronary dissection was made. The circumflex artery and the left coronary artery were stented, and then the LMCA was stented. Repeat intravascular ultrasound showed resolution of the dissection and TIMI-3 flow was achieved in all vessels. He underwent follow-up angiography in 1 month, which revealed patent stents with resolution of the aorto-coronary dissection. We report a rare case of iatrogenic aorto-coronary dissection that was successfully treated with unprotected left main percutaneous coronary intervention strategy alone and review the pertinent literature.