Spontaneous left main coronary artery dissection treated with primary stenting

Spontaneous left main coronary artery (LMCA) dissection is an unusual cause of myocardial ischemia and sudden death. It is defined as an intramural hematoma of the media of the vessel wall. A 56-year-old male who underwent a two-vessel bypass ten years previous presented with chest pain for two hours. His blood pressure and heart rate were 60/35 mmHg and 120 beats per minute, respectively. The ECG showed inferior ST-segment elevation. Coronary angiography revealed total LMCA occlusion with dissection flap. A dissection flap was collapsing the true lumen of the LMCA. A bare metal stent was implanted after the flap was perforated and fenestrated by a stiff guide wire. Good TIMI 3 flow was achieved in the circumflex artery. Three months after the index procedure, coronary computed tomography angiography disclosed thrombosis of the false lumen beneath the patent left main stent. In conclusion, primer stenting can be successfully performed in the presence of spontaneous LMCA dissection.