Author + information
- Received April 25, 2016
- Accepted May 5, 2016
- Published online August 8, 2016.
- Kayo Takahashi, MD,
- Shinji Inaba, MD∗ (, )
- Kenji Kikuchi, RT,
- Hiroe Aisu, MD,
- Toru Morofuji, MD,
- Makoto Saito, MD and
- Takumi Sumimoto, MD
- ↵∗Reprint requests and correspondence
Dr. Shinji Inaba, Department of Cardiology, Kitaishikai Hospital, 2632-3 Tokunomori, Ozu, Ehime 795-8505, Japan.
A 72-year-old man was admitted to our hospital presenting with cardiogenic shock following chest pain. Prehospital 12-lead electrocardiography showed lead aVR ST-segment elevation with widespread ST-segment depression, suggesting acute left main (LM) obstruction. Therefore, we decided to perform coronary angiography immediately after admission for release from broad myocardial ischemia. Emergent coronary angiography revealed severe LM obstruction (Figure 1A, Online Video 1), consistent with electrocardiography findings. First, we performed dilatation using a 2.5-mm balloon to open the LM obstruction. After the ballooning, we did an intravascular ultrasound observation for the investigation of the cause of LM closure. Intravascular ultrasound clearly showed a dissecting hematoma in the LM which extended from the aorta (Figure 1B, Online Video 2). We thus concluded that the cause of LM closure was acute type A aortic dissection. Bailout stenting with a 4.0 × 15-mm bare metal stent to the dissected LM was needed for the bridge to the cardiac operation because re-LM closure was observed by balloon angioplasty alone. Postprocedure computed tomography confirmed type A aortic dissection involving LM (Figure 2). He was transferred to another hospital for cardiac surgery. Intravascular ultrasound observation could provide us reliable information for diagnosis of life-threatening acute aortic dissection involving LM closure.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 25, 2016.
- Accepted May 5, 2016.
- American College of Cardiology Foundation