Case Management: Successful bail stenting performed by bursting a balloon in the false lumen to provide a channel between the true and false lumen (grenadoplasty/dissection reentry)
Actual treatment and management of the case
· Judkins left 4 6 French guide was used to engage the left main and sion wire was used to wire the left main however it entered the false lumen, subsequently a miracle 3 was used a parallel wire again entered the false lumen that was evident on distal double lumen catheter injection. Hence a 2.5x15 mini trek balloon was ruptured in the false lumen and a sion blue wire was used to recross into true distal lumen.
· A subsequent on distal double lumen catheter injection confirmed the true lumen (Video 2). Two drug eluting stents Medtronic Resolute Onyx were deployed 3x38 in the mid left anterior descending artery and 5x26 back to ostium of left main coronary artery (Video 3).
Video 2. Grenadoplasty/dissection reentry
Video 3. Final angiographic result
· TIMI 3 flow achieved in the left system with stable hemodynamics. The screening time was 33 min with 170 ml of contrast. Post procedure echo demonstrated mild left ventricular dysfunction.
· The patient was extubated 48 hours post procedure and required one-unit blood transfusion. As a result of the resuscitation, patient developed rib fractures that were treated conservatively and 9 days later patient was discharged home.
Iatrogenic left main dissection can be managed successfully percutaneously and prevents delay in restoring flow compared to conventional open-heart surgery. Percutaneously managed left main dissection has a similar survival compared to surgically managed individuals.