FREQUENCY AND MANAGEMENT OF ACUTE LEFT MA IN CORONARY-ARTERY DISSECTION AS COMPLICATION OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Out of 1730 consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) of left descending coronary artery (LAD) o r circumflex artery (CX) five patients (0.3%) suffered an acute dissec tion of left main coronary artery. In three patients dissection develo ped because of manipulation of the guiding catheter. In one patient re trograde dis section of the left main stem occurred because of balloon angioplasty of ostial LAD stenosis and in a second patient because of balloon rupture in the setting of stent deployment in the proximal pa rt of the LAD. Four patients were selected for emergency operation, bu t one patient died before reaching the operation theatre. Out of the t hree remaining patients one patient died postoperatively and another p atient suffered a transmural myocardial infarction. In the fifth patie nt three AVE Micro stents were implanted; one just at the origin of th e LAD, one at the origin of the CX and the third in the left main stem . This patient was nor sent for operation and was discharged without s ymptoms.