case_images: PMC6079505_01
case_images: Left coronary angiogram showing a moderate stenosis (arrow) of the left anterior descending coronary artery.
case_images: CRIC2018-5373625.001.jpg
case_images: PMC6079505_01_CRIC2018-5373625.001.jpg
case_images: fig1
case_images: The only angiographic abnormality noted was a moderate stenosis of the mid left anterior descending coronary artery (LAD) (Figure 1).
case_images: Occlusive dissection of the left main coronary artery.
case_images: CRIC2018-5373625.002.jpg
case_images: PMC6079505_01_CRIC2018-5373625.002.jpg
case_images: fig2
case_images: Angiography revealed only a stump of the left main coronary artery (LMCA) with occlusion of both the LAD and of the circumflex (LCx) coronary arteries (Figure 2).
case_images: Final deployment of the left anterior descending and left circumflex coronary artery stents with a kiss.
case_images: CRIC2018-5373625.003.jpg
case_images: PMC6079505_01_CRIC2018-5373625.003.jpg
case_images: fig3
case_images: Final deployment of the stents was with simultaneous inflation of the 2 balloons (kissing balloon dilation) (Figure 3).
case_images: Final angiographic result demonstrating patency of the left coronary system.
case_images: CRIC2018-5373625.004.jpg
case_images: PMC6079505_01_CRIC2018-5373625.004.jpg
case_images: fig4
case_images: Angiography demonstrated reestablishment of patency of the LM, LAD, and LCx (Figure 4), and intravascular ultrasound of the LAD and LM showed good stent apposition in these vessels.
case_images: Crossover balloon tamponade of the left femoral artery following removal of the Impella device.
case_images: CRIC2018-5373625.005.jpg
case_images: PMC6079505_01_CRIC2018-5373625.005.jpg
case_images: fig5
case_images: Because of the emergent need for Impella support in our patient, a technique of crossover balloon tamponade was used (Figure 5) with completion angiography to confirm hemostasis and absence of femoral artery abnormality or complication (Figure 6).
case_images: Final left femoral angiogram confirming hemostasis and absence of femoral artery abnormality or complication.
case_images: CRIC2018-5373625.006.jpg
case_images: PMC6079505_01_CRIC2018-5373625.006.jpg
case_images: fig6
case_images: Because of the emergent need for Impella support in our patient, a technique of crossover balloon tamponade was used (Figure 5) with completion angiography to confirm hemostasis and absence of femoral artery abnormality or complication (Figure 6).
case_images: Left coronary angiogram at 6-month follow-up showing continued patency of the previously placed stents.
case_images: CRIC2018-5373625.007.jpg
case_images: PMC6079505_01_CRIC2018-5373625.007.jpg
case_images: fig7
case_images: Follow-up coronary angiography 6 months after the initial procedure (Figure 7) showed continuing patency of the left coronary system without any significant residual stenosis.