LIMA Dissection

We discuss a case of iatrogenic catheter dissection of the LIMA. We review an important early angiographic sign of dissection, and go over stenting techniques as well as pitfalls to avoid when stenting dissected vessels.
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Chao-Wei Hwang, M.D., Ph.D.
Johns Hopkins University School of Medicine
Cardiac Cath Lab, Frederick Health Hospital

[@6intheA]

One of our astute viewers thought that the IVUS image actually showed that the IVUS catheter was in false lumen, and that the true lumen was to the right of the dissection flap. I thought we were true lumen throughout, but I must admit that sometimes I still have trouble telling things apart. Color doppler might have helped. In this case, we principally wanted to make sure that we ended in true lumen. This was clear in the full IVUS run (which I don't show). Fortunately for us, there are no branches to worry about in the LIMA, so it's less critical if part of the stent was in false lumen as long as the ends are in true lumen.... What I am sure of is this: The more I do this, the more I realize how much I still have yet to learn.