Bailout percutaneous coronary intervention for iatrogenic left main coronary artery dissection under Impella CP support: a case report

A 55-year-old woman was admitted with recurrent early-morning chest tightness approximately twice per month. Coronary computed tomography showed no significant stenosis.

During acetylcholine provocation testing, the patient developed extensive left main coronary artery (LMCA) dissection extending into the left anterior descending artery and left circumflex artery, resulting in thrombolysis in myocardial infarction (TIMI) Grade 1 flow and cardiogenic shock. A microaxial flow pump (Impella CP) was immediately inserted via the femoral artery, leading to rapid haemodynamic stabilization and improvement of ST-segment depression. Intravascular ultrasound demonstrated dynamic reduction of the false lumen and expansion of the true lumen after initiation of Impella support. Percutaneous coronary intervention was subsequently performed under the Impella support, with stent deployment from the LMCA to the left anterior descending artery (LAD), followed by kissing-balloon inflation into the left circumflex artery (LCx). Final angiography confirmed restoration of TIMI Grade 3 flow.

The patient experienced a favourable clinical course and was discharged after completing cardiac rehabilitation. This case highlights the potential role of early Impella support in stabilizing haemodynamics and preserving true lumen integrity during bailout percutaneous coronary intervention for iatrogenic LMCA dissection. Intravascular ultrasound provided valuable insights into haemodynamic improvements following Impella support.