Acute Type A Aortic Dissection with Acute Left Main Coronary Trunk Occlusion: A Case Report of Left Main Stenting as a Bridge to Surgery

(Department of Thoracic and Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan)

Masaharu Hatakeyama Yoshiharu Takahara
Kenji Mogi and Masashi Kabasawa
A 56-year-old man was admitted to our institution with sudden onset of severe chest pain and ischemia of the lower extremities on February 24, 2007. An enhanced computed tomography scan showed acute Stanford type A aortic dissection. Electrocardiography showed ST segment elevation in leads V1-4 and a transthoracic echocardiogram revealed antero-septal wall akinesis. The patient was given a diagnosis of acute myocardial infarction (AMI) caused by left main trunk dissection (LMT) due to acute aortic dissection. Coronary angiography (CAG) showed severe stenosis in the LMT with poor distal run-off. For this reason, after we implanted a stent in the left main coronary trunk to maintain coronary blood flow, we performed total aortic arch replacement, coronary artery bypass grafting (SVG-LAD8), and F-F cross-over bypass. Removal of the implanted stent from the LMT during the operation was simple. Postoperative CAG showed a patent SVG and intact LMT. Because preoperative PCI is still controversial for acute aortic dissection with AMI, either more immediate surgery or preoperative PCI (bridge stent to surgery) in the left main coronary artery is mandatory. Implantation of an LMT stent, as a bridge to surgery, is an effective strategy for acute type A aortic dissection with LMT occlusion before surgical repair.
@Jpn. J. Cardiovasc. Surg. 37: 353-357 (2008)