Coronary malperfusion in acute type A aortic dissection

, Coronary malperfusion in patients with aortic dissection further worsens prognosis due to compromised myocardial blood flow. The incidence rate of coronary disease goes from 9% to 10% according to various registries. 1,2 Also, it can occur simultaneously at the beginning of dissection, during the patient transfer or in the middle of surgery. The management of these patients is still a matter of discussion. The optimal time of myocardial reperfusion is 90 min, a timeframe that cannot be guaranteed with surgical revascularization associated with aortic valve repair surgery. This is the case of a 65-year-old man. The patient was a smoker with chronic kidney disease who was admitted to our center as a «myocar-dial infarction code» case due to suspected anterior ST-segment elevation acute coronary syndrome. The coronary angiography revealed the presence of a type A aortic dissection with coronary malperfusion due to left main coronary artery (LMCA) occlusion. The patient had reported to his tertiary referral center with a 30-min history of oppressive retrosternal chest pain. Upon arrival at the emergency room, he remained symptomatic and hemody-namically unstable (pale, sweaty,