Left Main Spontaneous Coronary Artery Dissection Complicated by Cardiogenic Shock.

OBJECTIVE

To review a case of left main spontaneous coronary artery dissection (SCAD) complicated by pulseless ventricular tachycardia arrest and cardiogenic shock in a 58-year-old woman without pre-existing cardiovascular risk factors, presenting as non-ST-segment elevation myocardial infarction.

KEY STEPS: Catheterization with pulmonary artery catheter placement was crucial in revealing left main SCAD with severe cardiogenic shock (Society for Cardiovascular Angiography & Interventions stage D). The patient required initiation of mechanical support with Impella-supported percutaneous coronary intervention with a drug-eluting stent to the left main coronary artery. Afterward, she had full recovery and was weaned off mechanical and vasoactive support.

POTENTIAL PITFALLS: While many SCAD cases are managed conservatively with medical therapy, left main involvement often requires early revascularization and is associated with a higher risk of complications.

TAKE-HOME MESSAGE: This case offers insight into the diagnostic and treatment strategies of left main SCAD and underscores the importance of early revascularization to improve outcomes.