A Case of Acute Type A Aortic Dissection with Acute Coronary Syndrome:Left Main Stenting as a Bridge to Surgery

Muneaki Yamada	Yasuyuki Kato	Aya Takahashi
Daisuke Shiomi	Hiroshi Kiyama

（Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Japan）

A 45-year-old man was hospitalized with sudden-onset chest pain. He was in cardiogenic shock with a systolic pressure of 68mmHg. His electrocardiogram（ECG）showed ST segment elevation in leads I, aVL, and V2-5. An emergency coronary angiogram（CAG）showed that the true lumens of bilateral coronary arteries were compressed, showing acute Stanford type A aortic dissection involving bilateral coronary artery. A bare metal stent was promptly implanted in the left main trunk（LMT）to restore coronary blood flow because of his hemodynamic instability. Soon afterwards, the ischemic changes on ECG disappeared and he was transferred to the operating room in a stable hemodynamic condition. We performed emergency graft replacement of the ascending aorta and coronary artery bypass grafting. The postoperative CAG showed patent bypass grafts. Implantation of LMT stent, as a bridge to surgery, should be the treatment of choice for acute type A dissection involving LMT.

 

Jpn. J. Cardiovasc. Surg. 45:254-257（2016）

Keywords：type A acute aortic dissection;acute myocardial infarction;left main stenting