Immediate and long-term outcomes of stent implantation for procedure-induced dissection of left main coronary artery

Background: Procedure-induced dissection of the left main coronary artery (LMCA) is a rare complication of coronary catheterization, but it may have fatal results. The outcomes of stent implantation in patients with procedure-induced LMCA dissection are still unclear. Method: From April 2002 to December 2005, 4852 patients underwent percutaneous coronary intervention (PCI) for coronary artery disease in this institute. During this period, 5 patients (0.1%) developed procedure-induced LMCA dissection during PCI, and they received stent implantation for this complication. Result: All of the 5 patients developed procedure-induced LMCA dissection during PCI for stenosis of the left anterior descending (LAD) artery. Procedure-induced dissection of the LMCA developed during manipulation of the guiding catheter in 1, after balloon dilatation for LAD stenosis in 1, and after stent implantation for LAD stenosis in 3 patients. Immediate success of stent implantation for LMCA dissection was achieved in all 5 patients. No major complication was noted during LM stenting. At a mean follow-up period of 43 ± 23 months (range 9 to 66 months), four of the 5 patients (80%) underwent repeated coronary angiography due to recurrent angina. One of 4 patients received PCI for restenosis of LMCA. There were no major cardiac events, including requirement of coronary artery bypass graft surgery, myocardial infarction or death during the follow-up period. Conclusion: LMCA dissection during PCI could be successfully managed by prompt stent implantation, with acceptable immediate and long-term outcomes.