Catheter-induced spiral dissection of the left main coronary artery.

A 44-year-old female with a history of chronic tobacco use presented with non-ST segment elevation myocardial infarction (NSTEMI) and atrial fibrillation, complicated by ventricular fibrillation (VF) arrest. At coronary angiography, the first injection in the left coronary artery revealed normal coronary arteries [Figures 1a and 1b]. On the following injection, a coronary dissection cap appeared at the tip of the catheter [Figure 2a], which extended antegradely on subsequent injections [Figure 2b]. She successfully underwent emergency aorto-coronary bypass graft surgery and was discharged 6 days later.

Figure 1a

Coronary angiography (left coronary artery): Semi-selective

Figure 1b

Coronary angiography (right coronary artery)

Figure 2a

Coronary angiography (left coronary artery): Dissection cap

Figure 2b

Coronary angiography (left coronary artery): Antegrade extension of left main dissection

Coronary artery dissection is a rare but potentially catastrophic complication of coronary angiography.

Management includes conservative treatment, coronary stenting, or coronary artery bypass graft surgery.[12]