Surgical management of instrumentation-induced coronary artery dissection.

The mechanism of instrument-induced coronary artery dissections (IICDs) is briefly presented. Depending on the coronary anatomy, three different situations that may occur are distinguished: (1) major coronary branches between the site of dissection and planned anastomosis; (2) no important collaterals at the same location; and (3) perforation of the coronary artery. Surgical methods applicable to each for the correction of these situations is presented.