A Case of an Acute Type A Aortic Dissection with Left Coronary Artery Malperfusion that was Successfully Stented as a Bridge to Surgery

Abstract

pericardial effusion. Other fi ndings were an ejec-tion fraction was 40%, a mild aortic regurgitation without dilation. Emergency coronary angiography was carried out on suspi-cion of ST elevation myocardial infarction through a right radial approach. Right coronary angiography showed no significant stenosis. Left coronary angiography revealed 99% stenosis at the proximal part of the left anterior descending artery (LAD). Left coronary angiography revealed collapse or dilation, which de-pended on the timing of the injection of contrast medium, or Although acute type A aortic dissection with obstruction of the coronary artery is frequently fatal, some case reports have shown the effectiveness of stenting as a bridge to definitive surgery. We report a case of a 72-year-old woman referred to our hospital with acute onset chest pain. Her history included stent grafting for an abdominal aortic aneurysm three months before surgery, and percutaneous coronary intervention for the left circumflex artery and right coronary artery one year prior to admission. Electrocardiogram findings indicated ST-segment elevation. Emergency coronary angiography showed a 99% stenosis at the proximal part of the left anterior descending artery. Intravascular ultrasound study revealed a hematoma located from the proximal part of the left anterior descending artery to the left main trunk. After implanting a drug eluting stent from the left main trunk to the left anterior descending artery, computed tomography revealed an acute type A aortic dissection. Ascending aortic replacement and coronary artery bypass grafting were performed. Successful implantation of the stent at the left coronary artery was a bridge to surgery for the patient.