Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2015; 7(2): 104-110
Published online Feb 26, 2015. doi: 10.4330/wjc.v7.i2.104
Coronary stenting with cardiogenic shock due to acute ascending aortic dissection
Yuichi Hanaki, Kazuhiko Yumoto, Seigen I, Hajime Aoki, Tomoyuki Fukuzawa, Takahiro Watanabe, Kenichi Kato
Yuichi Hanaki, Kazuhiko Yumoto, Seigen I, Hajime Aoki, Tomoyuki Fukuzawa, Takahiro Watanabe, Kenichi Kato, Department of Cardiology, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
Author contributions: Hanaki Y, Yumoto K and Kato K designed the report; Hanaki Y, Yumoto K and Fukuzawa T performed percutaneous coronary intervention; Aoki H analyzed IVUS findings; I S analyzed CT findings; Watanabe T collected the patient’s clinical data; Hanaki Y and Yumoto K wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazuhiko Yumoto, MD, PhD, Department of Cardiology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama 222-0036, Japan. kyumoto@db3.so-net.ne.jp
Telephone: +81-45-4748111 Fax: +81-45-4748322
Received: July 9, 2014
Peer-review started: July 10, 2014
First decision: September 9, 2014
Revised: October 7, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 26, 2015
Processing time: 217 Days and 6 Hours
Abstract

A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery (LMCA) to the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection (TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is effective for prompt diagnosis and precise stent deployment in patients with cardiogenic shock due to TAAD with LMCA dissection.

Keywords: Aortic dissection; Left main coronary artery; Myocardial infarction; Intravascular ultrasound; Coronary artery stenting

Core tip: Type A aortic dissection (TAAD) involving the left main coronary artery (LMCA) is a rare but potentially lethal condition. However, the precise diagnosis of TAAD prior to the treatment of acute myocardial infarction is difficult, and percutaneous intervention for LMCA obstruction secondary to TAAD is often complicated. This case report represents successful LMCA stenting under intravascular ultrasound (IVUS) guidance in a patient with cardiogenic shock due to TAAD with LMCA dissection. This procedure, particularly in terms of the use of IVUS, may be effective for rapid hemodynamic stabilization in patients in critical condition.