A nasty surprise: cardiogenic shock induced by extensive dissection of the left internal mammary artery graft occurring 3 months after coronary angiography-a case report.

Acute dissection of a LIMA graft is a rare event that may lead to a life-threatening condition. According to the literature, LIMA dissection happens during coronary interventions in approximately half of the cases but it also may evolve spontaneously. However, as seen from our case, there might be a substantial delay between LIMA angiography and the clinical onset of dissection. In the vast majority of cases, dissection of LIMA can be treated by PCI. The use of Impella as reported for the first time in this case may improve the safety of the procedure. In accordance to PCI of the native coronary arteries, it seems possible to leave non-flow limiting dissections in cases of extensive disease in order to avoid the late complications of complete stenting of the graft.