Aortic dissection is a medical emergency affecting 2 out of 10,000 people between the ages 40 and 70. It often occurs along the right lateral wall of the ascending aorta where the hydraulic shear stress is high and therefore more likely to involve the right coronary artery (RCA). Typical presenting symptom is sudden onset severe chest pain radiating to the back. Symptoms like syncope, aortic insufficiency, and bowel ischemia can result from complications of aortic dissection extending into other major arteries. Myocardial infarction resulting from extension of the dissection into the left main coronary artery (LM) is exceptionally rare and often fatal. Here we illustrate a case of type A aortic dissection extending into the LM managed with complex percutaneous coronary intervention (PCI), which traditionally, is treated with operative intervention and coronary artery bypass graft surgery. Given the advancement of intravascular ultrasound (IVUS) and stenting, recent case reports have demonstrated attempts at coronary stenting as a bridge to surgery. Our case will add to the literature of a possible technique at managing ascending aortic dissection extending into the LM.

Intramyocardial hemorrhage is present in approximately 40% of reperfused patients who experienced ST-elevation myocardial infarction. Intramyocardial hemorrhage is associated with major adverse cardiovascular events after ST-elevation myocardial infarction. Intramyocardial hemorrhage is associated with larger infarct size, lower ejection fraction, and larger left ventricular end-diastolic volume after ST-elevation myocardial infarction. Intramyocardial hemorrhage is associated with more frequent thrombolysis in myocardial infarction flow score of <3 after percutaneous coronary intervention and use of GP IIb/IIIa inhibitors. Predictors of intramyocardial hemorrhage after ST-elevation myocardial infarction are male sex, left anterior descending infarct, and smoking.

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Mishita
Jornal co-ordinator
Journal of Heart and Cardiovascular Research