A dual catastrophe in the left main coronary artery: iatrogenic dissection and dislodgement of the fully deployed stent

TL;DR

A rare case of iatrogenic dissection and stent dislodgement in the left main coronary artery was successfully managed without surgery.

Contribution

This is the first reported case of simultaneous LMCA dissection and retrograde stent dislodgement managed percutaneously.

Findings

The patient remained hemodynamically stable throughout the procedure.

The dislodged stent was implanted into the right brachial artery to prevent complications.

The case was successfully managed without surgical intervention.

Abstract

Iatrogenic left main coronary artery (LMCA) dissection and stent dislodgement are rare but potentially life-threatening complications of coronary angiography and percutaneous coronary intervention. Their simultaneous occurrence is extremely uncommon and poses significant technical challenges.

A 62-year-old man with a history of hypertension developed LMCA dissection accompanied by chest pain during coronary angiography performed via the right radial approach, caused by non-coaxial catheter engagement. To stabilize the dissection, an additional femoral access was obtained. A drug-eluting stent implanted from the circumflex artery to the LMCA adhered to the balloon and migrated retrogradely, becoming lodged at the tip of the guiding catheter. Because retrieval attempts were unsuccessful, the dislodged stent was intentionally implanted into the right brachial artery to prevent distal embolization. The patient remained hemodynamically stable throughout the procedure and was discharged without complications.

This case represents the first reported instance of simultaneous LMCA dissection and complete retrograde stent dislodgement successfully managed percutaneously without the need for surgical intervention. Prompt recognition, access modification, and careful device manipulation were essential for achieving a favorable outcome.

The online version contains supplementary material available at 10.1186/s12872-026-05563-9.

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