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Salvage angioplasty and stenting following spontaneous dissection of the left anterior descending coronary artery
A P Banning
Department
of Cardiology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
Correspondence to: Dr Banning
Accepted for publication 14 April 1999
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Article |
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A 46 year old woman presented with sudden onset severe,
tight, central chest pain. She had stopped smoking 10 years previously, but there were no other cardiac risk factors. The ECG showed sinus rhythm with marked ST elevation over the anterior chest leads, and she
received intravenous tPA within two hours of symptom onset. Despite
thrombolysis, diamorphine, and intravenous 
blockade, the
pain persisted. The ECG showed increased ST elevation.
She was transferred to the regional cardiac centre where examination
revealed persistent severe chest pain, tachycardia, and hypotension.
Coronary angiography showed an occlusive dissection flap in the
proximal left anterior descending coronary artery (fig 1A); circumflex
and right coronaries were normal. Balloon angioplasty resulted
in improved flow (fig 1B) and two overlapping intracoronary stents were
placed in the proximal and mid vessel (3.5 × 38 mm and
3.0 × 28 mm, Multilink; Guidant ACS, Basingstoke, UK). When the
procedure had been completed (fig 1C), it became
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