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A 55-year-old woman developed extensive LMCA dissection extending into the LAD and LCx during acetylcholine provocation testing, with TIMI Grade 1 flow and cardiogenic shock. Impella CP was inserted immediately via the femoral artery, achieving rapid haemodynamic stabilization and improvement of ST-segment depression. Intravascular ultrasound showed dynamic false-lumen reduction and true-lumen expansion, followed by LMCA-to-LAD stenting and kissing-balloon inflation into the LCx, restoring TIMI Grade 3 flow.",{"@graph":69,"@context":127},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/bailout-percutaneous-coronary-intervention-for-iatrogenic-left-main-coronary-artery-dissection-under-impella-cp-support-case-report/456408/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/bailout-percutaneous-coronary-intervention-for-iatrogenic-left-main-coronary-artery-dissection-under-impella-cp-support-case-report/456408.png","ImageObject",300,407,{"name":92,"@type":93},"Rainbow Cat","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119,123],{"name":110,"@type":111,"acceptedAnswer":112},"What triggered the patient’s coronary dissection in this case report?","Question",{"text":113,"@type":114},"During acetylcholine provocation testing, the patient developed extensive left main coronary artery dissection extending into the LAD and LCx.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did Impella CP affect haemodynamics and ECG findings?",{"text":118,"@type":114},"Impella CP insertion via the femoral artery led to rapid haemodynamic stabilization and improvement of ST-segment depression, with chest pain subsiding quickly after activation.",{"name":120,"@type":111,"acceptedAnswer":121},"What did intravascular ultrasound show after starting Impella support?",{"text":122,"@type":114},"IVUS demonstrated dynamic reduction of the false lumen and expansion of the true lumen after initiation of Impella support.",{"name":124,"@type":111,"acceptedAnswer":125},"What was the final result after the bailout percutaneous coronary intervention?",{"text":126,"@type":114},"Stenting from the LMCA to the LAD and kissing-balloon inflation into the LCx restored TIMI Grade 3 flow on final angiography, and the patient was discharged after cardiac rehabilitation.","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},456408,1791037010,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":52,"preview_page_count":4},962090769181,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","European Heart Journal-Case Reports (2026) 10, ytaf685 [https://doi.org/10.1093/ehjcr/ytaf685](https://doi.org/10.1093/ehjcr/ytaf685)  \nCASE REPORT  \nCoronary intervention  \nBailout percutaneous coronary intervention foriatrogenic left main coronary artery dissection under Impella CP support: a case report  \nYuki Nakata  , Takayuki Okamura  *, Masaki Tamitani, Tatsuhiro Fujimura, and Motoaki Sano  \nDivision of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-kogushi, Ube 755-8505, Japan Received 6 July 2025; revised 23 November 2025; accepted 15 December 2025; online publish-ahead-of-print 29 December 2025  \nBackground A 55-year-old woman was admitted with recurrent early-morning chest tightness approximately twice per month. Coronary computed tomography showed no significant stenosis.  \nCase summary 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.  \nDiscussion The patient experienced a favourable clinical course and was discharged after completing cardiac rehabilitation. This case highlights  \nthe 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.  \nKeywords Left main coronary artery dissection • Iatrogenic • Cardiogenic shock • Mechanical circulatory support • Intravascular  \nultrasound • Bailout procedure • Case report  \n- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  \nESC curriculum 3.1 Coronary artery disease • 2.1 Imaging modalities  \nLearning points  \n• Early mechanical circulatory support facilitates safe IVUS-guided revascularization during LMCA dissection.  \n• Understanding and maintaining true lumen integrity are crucial for favourable outcomes.  \n* Corresponding author. Tel: +81 836 22 2248, Email: [t-okamu@yamaguchi-u.ac.jp](t-okamu@yamaguchi-u.ac.jp)[ ](t-okamu@yamaguchi-u.ac.jp)Handling Editor: Helle Søholm  \nPeer-reviewers: Usnish Adhikari; Stefano Albani; Md Mashiul Alam  \nCompliance Editor: Deepti Ranganathan  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [reprints@oup.com](reprints@oup.com) for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on th","cbCaim9R257RemFp","https://ap.wps.com/l/cbCaim9R257RemFp","pdf",330458,"English","# Coronary intervention\n## Case report\n## Background\n## Case summary\n## Discussion\n## Learning points\n## Keywords","[{\"question\":\"What triggered the patient’s coronary dissection in this case report?\",\"answer\":\"During acetylcholine provocation testing, the patient developed extensive left main coronary artery dissection extending into the LAD and LCx.\"},{\"question\":\"How did Impella CP affect haemodynamics and ECG findings?\",\"answer\":\"Impella CP insertion via the femoral artery led to rapid haemodynamic stabilization and improvement of ST-segment depression, with chest pain subsiding quickly after activation.\"},{\"question\":\"What did intravascular ultrasound show after starting Impella support?\",\"answer\":\"IVUS demonstrated dynamic reduction of the false lumen and expansion of the true lumen after initiation of Impella support.\"},{\"question\":\"What was the final result after the bailout percutaneous coronary intervention?\",\"answer\":\"Stenting from the LMCA to the LAD and kissing-balloon inflation into the LCx restored TIMI Grade 3 flow on final angiography, and the patient was discharged after cardiac rehabilitation.\"}]","Bailout percutaneous coronary intervention for iatrogenic left main coronary artery dissection under Impella CP support - case report | PDF",1790745958]