Catheter-induced aortocoronary dissection at the ostium of anomalous left coronary artery during percutaneous coronary intervention for acute inferior myocardial infarction.

We report a case of catheter-induced aortocoronary dissection at the ostium of anomalous left coronary artery (LCA) during percutaneous coronary intervention (PCI) for acute inferior myocardial infarction (MI). Urgent coronary angiography revealed the culprit lesion of MI was the proximal segment of the right coronary artery (RCA). The anomalous LCA arose from the right sinus of Valsalva the same as the RCA. Catheter-induced aortocoronary dissection at the ostium of RCA was extended to the ostium of anomalous LCA by contrast injection. The patient fell into hemodynamic collapse due to acute occlusion of the anomalous LCA. The patient underwent successful bailout stenting at the ostium of anomalous LCA under percutaneous cardiopulmonary support (PCPS). He was weaned from PCPS system five days after PCI and was discharged. This is the first report about bailout procedure for catheter-induced aortocoronary dissection at the ostium of anomalous LCA. <Learning objective: We present a case of catheter-induced aortocoronary dissection at the ostium of anomalous left coronary artery in a patient with acute inferior myocardial infarction. Anomalous origin of the coronary artery arising from the opposite sinus of Valsalva is a rare congenital anomaly. Aortocoronary dissection is also a rare but well-known complication during cardiac catheterization. Precise information on anatomy of anomalous coronary arteries is essential for percutaneous coronary intervention and attention should be paid to the potential risk of complications.>.