Left Main Coronary Artery Dissection Complicating Diagnostic Coronary Angiography - PowerPoint PPT Presentation

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Left Main Coronary Artery Dissection Complicating Diagnostic Coronary Angiography

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Left Main Coronary Artery Dissection Complicating Diagnostic Coronary Angiography Layth A. Mimish MBChB, FRCPC, FACC Medical Director The Cardiovascular Consultant Clinic – PowerPoint PPT presentation

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Title: Left Main Coronary Artery Dissection Complicating Diagnostic Coronary Angiography


1
Left Main Coronary Artery DissectionComplicating
Diagnostic Coronary Angiography
  • Layth A. Mimish
  • MBChB, FRCPC, FACC
  • Medical Director
  • The Cardiovascular Consultant Clinic
  • Jeddah, KSA

2
  • I have no conflict of interest
  • pertaining to this presentation

3
Left Main Coronary Dissection
  • Definition and Classification
  • Incidence
  • Etiology
  • Management
  • Conservative
  • CABGS
  • Stenting

4
NHLBI Classification
5
Left Main Coronary Dissection
  • Spontaneous
  • Extension from Aortic Dissection
  • Complication of Diagnostic Coronary Angiography
    or Coronary Interventional procedure

6
Iatrogenic Left Main Coronary Dissection
  • Calcification of Lt. Main Stem
  • Anatomical distortion in aortic root or origin of
    Lt main that makes selective intubation difficult
  • The angle formed by the tip of the catheter and
    the intima of the vessel
  • The depth with which the artery is cannulated
  • Forceful injection with dampened pressure
  • Femoral Vs radial approach
  • Diagnostic Vs PCI

7
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8
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9
Left Main Coronary Dissection
  • Sones initial series 4200 diagnostic procedures,
    1 reported dissection
  • Massachusetts General Hospital 1970-1975 2981
    Pts, Lt. main dissection in 1
  • Dennis, W., William ONeil, Cath C V Intervention
    2000, data review 43,143 diagnostic procedures
    and PCI (0.02)
  • Carter AJC 1994 3cases, incidence 0.02 for
    diagnostic angiography, and 0.07 for PCI
  • Under-reported, with severity varying from type
    A to severe aortic root dissection

10
Conservative Treatment
11
CABG Vs Medical Therapy
12
ACC / AHA Guidelines
13
Clinical Outcomes with CABG in Lt. Main Disease
  • 18 Centers
  • Jan 2001-June 2003
  • 5,494 Consecutive CABG with no exclusion
  • 1,394 Lt main (24.1)
  • Operative mortality 4.1 (All other CABG 2.3)
  • CVA 1.3

  • Katz, Mack, Simon

14
OPCAB in LMCA Disease
Off Pump On Pump
n 273 1,163
Predicted Mortality 4.1 3.6
Observed Mortality 2.6 4.5
Risk Adjusted Mortality 1.9 3.8
Dewey,et al, Ann Thorac Surg 2001
15
Motality for CABG in Lt Main
NYS Database 1997-2000
16
Stent Vs Conventional Rxfor Abrupt Closure or
Symptomatic Dissection
17
French Lt Main RegistryMay 2001-June 2002 (11
French Centers)
18
French Lt Main Registry1 Yr Outcome
19
French Lt Main Registry1 Month 1 Yr Outcome
20
French Lt Main Registry1 Month 1 Yr Outcome
21
French Lt Main Registry1 Month 1 Yr Outcome
22
IVUS Optimization for Stent Deployment
23
DES Vs BMS in Milan6 Month Clinical
Angiographic F/Up
24
DES in Lt Main DiseaseRESEARCH T-SEARCH
Registry
  • April 16, 2002-Dec 31, 2003
  • gt 50 Lt min
  • Consensus agreement with CV surgeon with patient
    and referring MD
  • 95 Consecutive Pts, with 1 DES (SES 52, PES 43)
  • Comparison group 86 Consecutive pts who got BMS
    for Lt main immediately before DES availability
  • Median F/UP 503 days (331-873)

25
DES in Lt Main DiseaseRESEARCH T-SEARCH
Registry
26
LMCA Intervention in AMC
27
In Hospital Outcome
28
Overall Restenosis rate 7.9
29
6 Months Clinical Outcome
30
MACE Free Survival at 1 Year
31
Coclusion
  • Rapid thorough assessment
  • CV Surgeon involved
  • Haemodynamic support
  • DES Vs emergency CABGS
  • IVUS
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