| A case of left main coronary artery dissection during diagnostic radial coronary angiography treated by bail-out stenting |
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고려대학교 의과대학 내과학교실 |
| 증례 : 요골동맥을 이용한 진단적 관상동맥 조영술중 발생한 좌주간부 관상동맥 박리증 1예 |
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김준영 |
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| Abstract |
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Coronary angiography is a routine diagnostic procedure in current clinical practice. However, it is not without risk to the patient and potential life-threatening complications can occur using both a transfemoral and transradial approach.
Catheter-induced left main coronary artery (LMCA) dissection is uncommon but is serious and can result in death of the patient. A 66-year old male patient that underwent coronary angiography via the transradial approach because of unstable angina was diagnosed at the outpatient clinic. A coronary angiogram revealed diffuse stenosis at the left anterior descending artery (LAD), but it was complicated by catheter-induced dissection of the LMCA extending to the mid segment of the LAD and an observed reduction in distal coronary flow. The patient complained of severe chest pain and severe perspiration. On ECG, ST-segment elevation was noted, but blood pressure was maintained. Immediately, we punctured the right femoral artery and a guiding catheter was properly positioned with caution. After the guide wire was passed through to the true lumen, balloon angioplasty was performed, but failed to improve coronary flow. Next, we deployed a long drug-eluting stent from ostium of the LMCA to the distal dissection site. After stenting, the pain subsided and the ST-segment was normal. A follow-up coronary angiogram showed a small amount of dye staining at the LMCA but in the final angiogram, taken within the time interval, there was no increase amount of dye staining. It was decided to finish the procedure and a second procedure 7 days late was planned. A review of the diagnostic angiogram revealed a tapping motion of the catheter tip at the ostium of LMCA according to the cardiac cycle.(Korean J Med 72:S186-S190, 2007)
Key Words : Left main coronary artery, Dissection, Bail-out stenting |
| Key Words:
Left main coronary artery, Dissection, Bail-out stenting |
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