Optimal Wiring Direction in Iatrogenic Left Main Coronary Artery Dissection

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IMAGE(S): Intracoronary imaging is useful in evaluating iatrogenic left main coronary artery dissection. However, the optimal initial wiring direction remains unclear. CASE SUMMARY: We report 4 cases of iatrogenic left main coronary artery dissection caused by coronary catheters. In all cases, the dissection entry was on the epicardial side, and the true lumen was located on the myocardial side. Bench analysis showed that commonly used left coronary catheters consistently aligned toward the epicardial side. These findings suggest that wiring toward the myocardial side in the left anterior oblique projection may enable rapid restoration of flow. TAKE-HOME MESSAGE: Wiring toward the myocardial side may facilitate rapid access to the true lumen in iatrogenic left main dissection.

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