Stent-supported angioplasty of a residual coronary artery dissection following replacement of the ascending aorta for acute type A aortic dissection.

The patient was a 54-year-old male who suddenly noted severe back pain while eating. A diagnosis of acute type A aortic dissection was made on contrast enhanced CT. As a result, emergency surgical repair was performed on the same day. Through median sternotomy, graft replacement of the ascending aorta, including removal of the site of the intimal tear, was carried out under deep hypothermia and retrograde cerebral perfusion. Although the postoperative course was satisfactory, the patient complained of severe chest pain with ECG change on the 23rd postoperative day. Emergency coronary angiography revealed the presence of wide coronary artery dissection from an entry of the left anterior descending aorta (LAD) to a reentry of the left circumflex artery (LCX). Multiple stents were implanted in the LAD and LCX. After stenting, chest symptoms were relieved, and ECG change disappeared. He was discharged from our hospital on the 42nd postoperative day.