Novel use of a guiding catheter to relieve left main stem occlusion complicating Stamford type A aortic dissection

Acute ST elevation myocardial infarction occurring as a result of acute aortic dissection is a relatively rare complication with an incidence of 1-2%. However, despite this the outcome is frequently fatal. This report documents novel use of a percutaneous guiding catheter to relieve left main stem occlusion complicating Stamford type A aortic dissection, as a bridge to successful surgical treatment. A 62-year-old man presented with acute chest pain and electrocardiographic changes consistent with acute anterior myocardial infarction, and was sent for primary percutaneous coronary intervention. Angiography demonstrated an acute Stamford type A aortic dissection with associated secondary myocardial infarction caused by mechanical obstruction of the left main coronary artery by the dissection flap. Engagement of the coronary ostium with a guide catheter relieved the obstruction and allowed transfer of the patient to the operating theatre where surgery was successfully performed.