1. Management of LCA-LM dissection.
Bogdan Gorycki
American Heart of Poland
Ustron, Poland

2. Case report 42 years old female Effort angina, diseaness, syncope
Hypertension
Diabetes mellitus
Hypothyreosis
Overweigth (body weight 120 kg)

3. Non-invasive tests UKG: LV function normal EKG: ST/T changes at rest
Spiral CT: hypoplasia of left vertebral artery, no significant lesion in carotid arteries, right vertebral artery ostial lesion.

4. Further diagnosis
The patient scheduled for coronary artery and carotid/vertebral angiogragphy

5. LCA: RAO30, Caudal 15

6. LCA: LAO 55, Cranial 22
Dissection LM/Cx
Time: 22:50
Dissection LAD/D1

7. Fast diagnosis and problem solving
Diagnosis: Spiral dissection of LM, LM bifurcation, proximal Cx and proximal LAD/D1
Management: -stop diagnostic procedure -immediate proceeding to LM stenting: -6F JL Guiding catheter -two soft wires (BMW, Guidant)

8. Fast wiring of LAD and Cx
Time: 22:55
Aortic pressure: 90/50 mmHg
HR: 110/min ECG: ST elevation.
Chest pain treated
with analgetics.

9. Direct stenting LM/LAD
Time: 23:00
Time: 22:57
Aortic pressure: 80/40 mmHg
HR:120/min.
Aortic pressure:
100/60 mmHg
HR 90/min.
After LM/LAD stenting
BX Velocity 3.5x23mm 18 atm., 15 sec.

10. Cx stenting Stent Bx Sonic 3.5x13mm
Re-wiring Cx wire and predilatation
Ostium Cx with2.5 balloon
Stent Bx Sonic 3.5x13mm
in position.

11. Final result:
Time: 23:16
LCA:RAO30, Caud22
LCA: LAO52, Caud 14

12. One-stage VA stenting:
Direct stenting:
BX Velocity 4.0x13mm
Ostial stenosis (90%)
of right VA artery

13. Conclusions
LM stenting is life saving procedure in patients with LM dissection which occurs during diagnostic or therapeutic percutaneous coronary intervention.
The procedure should be included to routine training and practice.