Stenting of a left main coronary artery dissection and stent-graft implantation for acute type a aortic dissection.

PURPOSE: To report successful endovascular repair of Stanford type A acute aortic dissection associated with a proximally extended dissection of the left main coronary artery.

CASE REPORT: A 71-year-old man presented with acute type A aortic dissection. One day after admission, dissection of the left main coronary artery accompanied by severe myocardial ischemia prompted Palmaz stent placement. Three days later, a customized stent-graft was placed across the entry site of the dissection in the descending aorta. The false lumen in the ascending aorta, transverse arch, and the descending thoracic aorta thrombosed, and the left coronary artery remained patent. At 14 months after the procedures, the patient is doing well and has had no cardiac event.

CONCLUSIONS

This staged procedure may be one option for the management of acute type A aortic dissection complicated by coronary artery dissection.