• Images in cardiology

Iatrogenic left coronary dissection is fortunately rare. In this case haemodynamic collapse ensued necessitating the use of ionotropes and an intra-aortic balloon pump (top left panel). This stabilised the patient. There was no operating theatre free for urgent coronary bypass grafting. Introduction of a guidewire into the left anterior descending (LAD) coronary artery improved the situation, as did stenting of the left main stem (bottom left panel). The LAD and circumflex arteries were then stented in turn distal to proximal using eight stents in total (top right panel). The patient was well the following day with no troponin rise, and a normal 12 lead ECG and echocardiogram. Repeat angiography six months later showed only mild restenosis and the patient was pain-free with a normal exercise tolerance (bottom right panel).