Letter to the Editor Percutaneous treatment of severe retrograde dissection of the circumflex artery involving left main stem and extending into the sinus of Valsalva Gabriele L. Gasparini ⁎ , Dennis Zavalloni Parenti, Marco Luciano Rossi, Paolo Pagnotta, Guido Belli, Patrizia Presbitero Department of Invasive Cardiology, Istituto Humanitas, Milano, Italy Received 9 May 2007; accepted 11 May 2007 Available online 15 August 2007 Keywords: Angioplasty; Aorta; Complications; Stents; Valsalva; Dissection 1. Introduction Complications requiring emergency surgery during per- cutaneous coronary interventions (PCI) have become rare. The reduction is likely to be due to improved materials technology, increased operator's experience and skill, and improved adjunctive pharmacology. Life-threatening com- plications, however, do still occur. The following case report describes the emergency management of complications aris- ing during routine coronary angioplasty. 2. Case report A 74-year-old severly hypertensive woman with new onset severe unstable angina and a positive exercise stress test, was admitted to our catheterization laboratory to undergo a diagnostic coronary angiography. The procedure was per- formed from the femoral approach and showed presence of two vessels coronary artery disease (CAD) with severe steno- sies of the proximal left anterior descends (LAD) and of the mid circumflex (CX) coronary arteries (Fig. 1). She was already on treatment with aspirin and she was preloaded with 300 mg of clopidogrel. Immediately after the angiogram a percutaneous coronary intervention (PCI) of the two vessel was planned. A intraarterial bolus of heparin (5000 UI) was given at the beginning of the procedure. Enagagement of the left main stem (LMS) was perfomed with an Extra Back-up Left 4.0 (Medtronic) guiding catheter. The lesion in the proximal LAD was successfully treated with a 2.75×16 mm Taxus paclitaxel-eleuting stent (Boston Scientific). After direct Taxus paclitaxel-eluting stenting (3.0 × 16 mm) of the lesion in the mid CX, a contrast injection revealed spiral dissection of International Journal of Cardiology 130 (2008) 494 – 496 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Department of Invasive Cardiolgy, Istituto Humanitas, Via Manzoni 56, 20089 Rozzano (Milan), Italy. Tel.: +39 02 82243601; fax: +39 02 82243690. E-mail address: giellegi@hotmail.com (G.L. Gasparini). Fig. 1. Diagnostic coronary angiography showed presence of two vessels CAD with severe stenosies of the proximal LAD and of the mid CX coronary arteries (see arrows). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.05.109