Açık kalp cerrahi desteği olmayan bir merkezde iatrojenik sol ana koroner arter diseksiyon yönetimi

Katatere bağlı iatrojenik sol ana koroner arter diseksiyonu son derece nadir görülen ancak erken farkedilip tedavi planlaması yapılmadığında ölümcül sonuçlara sebep olabilen bir komplikasyondur. Güncel yaklaşımda konservatif izlem, perkutan girişimle bailout stentleme, bypass cerrahisi tedavi seçenekleri mevcuttur. Ancak bazı merkezlerde cerrahi destek olmadan koroner anjiografi ve girişimsel uygulamalar yapılmaktadır. Bu gibi nadir ama önemli komplikasyonların yönetimi bu merkezlerde daha karmaşık hale gelmektedir. Bu konuda yaşadığımız bu tecrübede stent implante edebilmek için kateteri derin entübasyon yapmak durumunda kaldığımız 72 yaş bayan hastada katetere bağlı gelişen iatrojenik sol ana koroner arter diseksiyonunu cerrahi destek olmayan merkezde bailout stentleme ve konservatif yaklaşımla nasıl yönettiğimizi kendisinin onayı alındıktan sonra paylaşmak istedik.

Anahtar Kelimeler:

Koroner arter diseksiyonu, Stent, Anjiografi

Management of iatrogenic left main coronary artery dissection in a center without onsite cardiac surgery back up

Catheter-related iatrogenic left main coronary artery dissection is an extremely rare complication that can cause fatal outcomes if not recognized and treated early. In the current approach, conservative follow-up, bailout stenting with percutaneous intervention and bypass surgery treatment options are available. However, in some centers, coronary angiography and interventional applications are performed without surgical support. Management of such rare but important complications becomes more complex in these centers. In this experience, we wanted to share after her approval, how we managed catheter-induced iatrogenic left main coronary artery dissection in a 72-year-old female patient with bailout stenting and conservative approach in a center without surgical back up.

Keywords:

Coronary artery dissection, Stent, Angiography,

PDF

___

1. Cheng CI, Wu CJ, Hsieh YK, Chen YH, Chen CJ, Chen SM, et al. Percutaneous coronary intervention for iatrogenic left main coronary artery dissection. Int J Cardiol. 2008;126:177-82.
2. Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seiler C, et al. Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up. Am Heart J. 2010;159:1147-53.
3. Awadalla H, Sabet S, El Sebaie A, Rosales O, Smalling R. Catheter-induced left main dissection incidence, predisposition and therapeutic strategies experience from two sides of the hemisphere. J Invasive Cardiol. 2005;17:233-6.
4. Onsea K, Kayaert P, Desmet W, Dubois CL. Iatrogenic left main coronary artery dissection. Neth Heart J. 2011;19:192-5.
5. Yıldırım O, Gul M, Inci S, Aktaş H, Dogan P, Bozkır A, et al. A catastrophic nightmare of the interventional cardiologist: Iatrogenic left main artery dissection and longitudinal stent deformation. Intractable Rare Dis Res. 2018;7:209-12.
6. Alfonso F, Almería C, Fernández‐Ortíz A, Segovia J, Ferreirós J, Goicolea J, et al. Aortic dissection occurring during coronary angioplasty: angiographic and transesophageal echocardiographic findings. Cathet Cardiovasc Diagn. 1997;42:412-15.
7. Celik M, Yuksel UC, Yalcinkaya E, Gokoglan Y, Iyisoy A. Conservative treatment of iatrogenic left main coronary artery dissection: report of two cases. Cardiovasc Diagn Ther. 2013;3:244-6.
8. Awadalla H, Salloum JG, Smalling RW, Sdringola S. Catheter‐Induced Dissection of the Left Main Coronary Artery With and Without Extension to the Aortic Root: A Report of Two Cases and a Review of the Literature. J Interv Cardiol. 2004;17:253-7.
9. Baysal SS, Özbek K, Cirit A. Iatrogenic Left Main Coronary Artery Dissection–A Disastrous Complication. J Cardiol Forecast. 2018;1:1002.