Spiral dissection of the left coronary artery as a rare and serious complication of coronary angiography: a case report

Background: Iatrogenic spiral dissection of the coronary artery is a rare but serious complication of Coronary angiography (CA). CA is a standard imaging method, which is considered as a safe and commonly used.Aim of the study: To demonstrate a rare complication of CA that significantly changed the patient’s outcome.Material and methods: A retrospective review of the procedure and the patient’s follow-up has been performed.Case report: A 56-year-old woman with type two atrial septal defect complicated by heart failure (HF), complaining of a gradual HF worsening and two episodes of syncope was admitted for preoperative assessment. Prior to cardiac surgery an elective CA revealed no stenoses in coronary arteries, however it was complicated by the spiral dissection of the left main coronary artery continuing towards the left anterior descending artery. Immediate percutaneous coronary angioplasty was performed with a good acute angiographic and clinical result. Subsequently, the patient developed a periprocedural inferolateral myocardial infarction and cardiac arrest due to pulseless electrical activity. Cardiopulmonary resuscitation was ineffective.Conclusion: The take home message of the case presented is that even a relatively safe procedure may be complicated and that less invasive imaging modalities should be considered prior to CA.