DOI: 10.36347/sjmcr.2019.v07i01.023

Pages: 78-81

A 87 year-old hypertensive woman was admitted to our emergency department with NSTEMI diagnosis. Coronary angiography showed a 90% Left Main Coronary Artery (LMCA) calcified lesion and a 90% proximal LAD lesion. Angioplasty was planned in the same procedure, using radial approach 6Fr, we tried first a Launcher Extra Back Up (EBU) 3.5 6Fr guide catheter but for the lack of support, we changed for an Amplatz Left I (AL I) guide catheter. Successfull reperfusion of the LAD lesion was achieved with a 2,5 mm x 33 mm Drug Eluting Stent, then we managed to treat the LM lesion ; Just after inflating a small ballon 3.0 x 12 mm in the ostium of the LMCA, we observed in angiographic control that contrast agent was stranded in the proximal area and spread outside of the aortic wall. Urgent aortic computed tomography angiography (CTA) showed that the dissection expanded to the ascending aorta and a large hematoma compressing the arterial pulmonary trunk. The patient was then transferred to the Department of Cardiac Surgery ; Decision for surgery was postponed and close monitoring leads to improved patient’s condition. Control CTA revealed no persistent pericardial effusion and hematoma, the patient was thus discharged.