PMC8086646_01
A. Normal electrocardiogram at admission; B. Electrocardiogram revealing ST elevation in V1; C. Transthoracic echocardiography at admission showing dilated left ventricle with 30% ejection fraction; D. Monitor polygraph record during transcatheter ablation; E. Left anterior descending coronary artery (LAD) dissection (white arrowheads); F, G. Abrupt total LAD closure (asterisks) and guidewire crossing; H, I. LAD drug eluting stent (DES) positioning and implantation (yellow dashed lines); J. DES positioning on left main (LM)-LAD (yellow dashed lines); K, L, M. Intravascular ultrasound (IVUS) run: IVUS images showing the extension of the dissection flap at the level of the LM (K: red arrowheads) and the optimal stent covering after stenting (M). IVUS at the level of the mid LAD shows medial thickening (L: between brackets); N: Final optimization with kissing balloon technique; O. Final angiographic result after LM-LAD percutaneous coronary intervention with DES implantation (yellow dashed lines).
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During an inducibility test the patient complained of retrosternal pain associated with ST elevation in the V1 lead (Fig. 1A-D). A percutaneous coronary intervention with a 3.5 x 38 mm zotarolimus- eluting stent implantation at the LAD ostium was performed (Fig. 1E-J). A good angiographic result was confirmed by a final IVUS run that demonstrated correct stent apposition through the LM-LAD axis (Fig. 1K-O).