Immediate bail-out TAP-stenting for the treatment of iatrogenic aortocoronary dissection involving left main bifurcation
A 77-year-old female had been suffering from ischemia-related chest pain for 6 years. She had a history of hypertension. Her cardiac, renal, liver functions were normal. Transradial coronary angiography revealed severe lesions in proximal LAD and mid LCX (, ). There was no critical stenosis in the LM and right coronary artery. A sirolimus-eluting stent (2.5/28 mm, CypherSelect, Cordis) was successfully implanted in LCX. When performed pre-dilation in mid LAD by semi-compliant balloon (2.5/15 mm, Voyager, Abbott), a retrograde dissection extended from mid LAD to LM and aorta (, white arrows). Despite obliteration of the LM-LAD dissection with two stents (2.75/33 mm in LAD, 3.5/33 mm in LM, CypherSelect, Cordis), retrograde extension of LCX dissection was present on subsequent angiographic view (, white arrow). Thereafter, we performed TAP-stenting in the LM bifurcation (2.75/33mm in LCX, CypherSelect, Cordis) by transradial approach (, ). Fortunately, the vital signs remained stable during the 15 minutes rescue. The patient was discharged without any complication, and 1-year follow-up indicated stent patency and favorable clinical result (, ).