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Iatrogenic Aortocoronary Dissection During Percutaneous Coronary Intervention: Investigation and Management.

ABSTRACT: We present a case of iatrogenic aortocoronary dissection sustained during routine percutaneous coronary intervention for stable angina. Careful wiring of the true lumen and stent implantation to seal off the dissection flap prevented immediate complications, and computed tomography aortography guided a conservative approach to manage the residual aortic dissection. (Level of Difficulty: Intermediate.).

SUBMITTER: Hung J

PROVIDER: S-EPMC8305681 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Iatrogenic Aortocoronary Dissection During Right Coronary Artery Procedures: A Systematic Review of the Published Literature.

Project description:Iatrogenic aortocoronary dissection (IACD) occurs mainly during procedures involving the right coronary artery (RCA) and can result in disabilities, the need for urgent complex surgery, and even death. The risk factors for IACD are ill characterized, and the best management strategy is questionable; thus, there is a need to evaluate the characteristics, treatment options, and outcomes of patients with IACD of the RCA. We searched medical databases for publications on IACD of the RCA to present the characteristics of the procedures, management, and outcomes. We report 142 cases of IACD of the RCA, reported between 1973 and 2021. The mean age of the patients was 63.0 years, 81 (57%) were men, 75 (52.8%) presented with stable angina, and 29 (20.4%) had chronic total occlusion of the RCA. The most used catheter shapes were Judkins right (42%) and Amplatz left (25%), and most (56%) catheters were used during percutaneous coronary interventions. Guiding catheters were used in 38% (19/50) of diagnostic procedures when IACD occurred. A catheter size of ≤5F was used in only 3 cases. The catheter size was 6F in 22% of the cases, >6F in 23%, and not reported in 52%. A high-grade dissection (Dunning class III) occurred in 54% (77/142) of the cases. Stenting of the RCA ostium was performed in 88 (62%) of the cases, conservative treatment in 25 (18%), and surgery in 40 (28%) (aortic root repair [5%], coronary artery bypass grafting and aortic root repair [11%], and coronary artery bypass grafting alone [10%]). The mortality rate was 6.5% (5/77) among patients with class III dissection. Each patient should be considered independently. The most frequent intervention was to seal the dissection with a stent in the ostial RCA. However, in select cases published in the literature, a conservative approach was a feasible and successful option.

| S-EPMC11308116 | biostudies-literature

Catheter-induced aortocoronary dissection at the ostium of anomalous left coronary artery during percutaneous coronary intervention for acute inferior myocardial infarction.

Project description:We report a case of catheter-induced aortocoronary dissection at the ostium of anomalous left coronary artery (LCA) during percutaneous coronary intervention (PCI) for acute inferior myocardial infarction (MI). Urgent coronary angiography revealed the culprit lesion of MI was the proximal segment of the right coronary artery (RCA). The anomalous LCA arose from the right sinus of Valsalva the same as the RCA. Catheter-induced aortocoronary dissection at the ostium of RCA was extended to the ostium of anomalous LCA by contrast injection. The patient fell into hemodynamic collapse due to acute occlusion of the anomalous LCA. The patient underwent successful bailout stenting at the ostium of anomalous LCA under percutaneous cardiopulmonary support (PCPS). He was weaned from PCPS system five days after PCI and was discharged. This is the first report about bailout procedure for catheter-induced aortocoronary dissection at the ostium of anomalous LCA. <Learning objective: We present a case of catheter-induced aortocoronary dissection at the ostium of anomalous left coronary artery in a patient with acute inferior myocardial infarction. Anomalous origin of the coronary artery arising from the opposite sinus of Valsalva is a rare congenital anomaly. Aortocoronary dissection is also a rare but well-known complication during cardiac catheterization. Precise information on anatomy of anomalous coronary arteries is essential for percutaneous coronary intervention and attention should be paid to the potential risk of complications.>.

| S-EPMC6149560 | biostudies-literature

Iatrogenic type A aortic dissection complicating percutaneous coronary intervention: a case report.

Project description:Iatrogenic type A dissection caused by percutaneous coronary intervention is a rare but life-threatening condition. Computed tomographic angiography is an excellent diagnostic tool commonly utilized if such procedural complication is clinically suspected. There are, however, potential diagnostic challenges. Herein, we present an illustrative case of iatrogenic type A dissection successfully diagnosed on computed tomography angiography along with a potential diagnostic pitfall.

| S-EPMC5551993 | biostudies-other

Successful Percutaneous Management of Iatrogenic Left Main Coronary Artery and Ascending Aorta Dissection.

Project description:Iatrogenic left main coronary artery and aortic root dissection is a rare but life-threatening complication of percutaneous coronary intervention. This is a case where this complication was induced by catheter manipulation. Prompt percutaneous closure of the dissection point of entry was effective in managing this complication. (Level of Difficulty: Advanced.).

| S-EPMC9175197 | biostudies-literature

Delayed percutaneous coronary intervention for an extensive iatrogenic left main coronary artery dissection: a case report.

Project description:BackgroundIatrogenic left main coronary artery dissection is a rare but serious complication that can occur both during diagnostic coronary angiography and percutaneous coronary intervention. Early diagnosis and choice of optimal management are of crucial importance for patient's outcome while representing a challenge for clinicians.Case presentationWe present a case of iatrogenic left main coronary artery dissection occurring during diagnostic coronary angiography in a 53-year-old Greek woman with a history of coronary artery bypass grafting. Although dissection was greatly extending to mid left anterior descending artery, delayed percutaneous coronary intervention was successfully performed by carefully wiring the true lumen.ConclusionsDelayed percutaneous coronary intervention, performed 25 days following the index event, proved to be a feasible and effective strategy for treating a widely extended left main coronary artery iatrogenic dissection.

| S-EPMC9743719 | biostudies-literature

Percutaneous Coronary Intervention for Iatrogenic Right Coronary Artery Dissection Post Bentall Procedure: A Case Report and Minireview.

Project description:Iatrogenic coronary artery dissection is a potentially life-threatening complication of cardiovascular interventions. The optimal management of iatrogenic coronary artery dissection is not clear; however, both conservative management and percutaneous or surgical revascularization have been performed depending on the patient's clinical status and the extent of dissection. We present the first reported case of right coronary artery dissection after Bentall procedure performed for ascending aortic aneurysm. Urgent percutaneous intervention using adjunctive coronary imaging was performed with excellent clinical recovery. In this article, we highlight coronary artery dissection after Bentall procedure as a possible complication, provide an insight into various options in its management, and review published data on iatrogenic coronary artery dissection. We also discuss the challenges in percutaneous treatment of coronary artery dissection with special focus on intracoronary imaging for accurate diagnosis and guidance in the management of this complex lesion.

| S-EPMC6231389 | biostudies-literature

Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systematic review of the literature.

Project description:BACKGROUND:Aortocoronary dissection can complicate percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). METHODS:We retrospectively examined the frequency and outcomes of aortocoronary dissection among 336 consecutive CTO PCIs performed at our institution between 2005 and 2012 and performed a systematic review of the published literature. RESULTS:Aortocoronary dissection occurred in six patients (1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections occurred in the right coronary artery (CTO target vessel in five patients and donor vessel in one patient). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar. Compared to patients without, those with aortocoronary dissection were more likely to undergo crossing attempts using the retrograde approach (25% vs. 67%, P?=?0.036) and experience a major complication (2.4% vs. 33.3%, P?=?0.008). Technical and procedural success rates were similar in both groups. Of the six patients with aortocoronary dissection one underwent emergency coronary bypass graft surgery (CABG), four were treated with ostial stenting, and one was treated conservatively without subsequent adverse clinical outcomes. Systematic literature review provided 107 published cases of aortocoronary dissection during PCI, that occurred mainly in the right coronary artery (74.8%) and were treated with stenting (49.5%), emergency CABG (29%), or conservatively (21.5%). CONCLUSIONS:Aortocoronary dissection is an infrequent complication of CTO PCI and although it can be treated with stents in most patients, it may infrequently require emergency CABG.

| S-EPMC4053511 | biostudies-literature

Surgical management of iatrogenic left main coronary artery dissection.

Project description:This is the case of a 40-year-old female diagnosed with NSTEMI. She underwent coronary angiography and suffered from type F left main coronary artery dissection. After hemodynamic stabilization, she was transferred to the nearest cardiothoracic surgery unit and underwent emergency coronary artery bypass graft (CABG) surgery. This report highlights important concepts in the management of a rare complication and emphasizes the surgical treatment decision-making, underlying an unusual but effective treatment approach.

| S-EPMC6007241 | biostudies-literature

Iatrogenic aortic regurgitation following percutaneous coronary intervention: Role of transesophageal echocardiography in the detection and management.

Project description:The incidence aortic valve injury during percutaneous coronary intervention is scarce, mostly resulting in acute aortic regurgitation. However, rarely patients may remain asymptomatic in the immediate post-procedure period and present latter with chronic aortic regurgitation. Determining etiology of such an aortic regurgitation may be challenging. We present a case of a 51-year-old man with history of percutaneous coronary intervention for coronary artery disease and moderate aortic regurgitation scheduled for coronary artery bypass grafting and aortic valve replacement. Intra-operative transesophageal echocardiography was instrumental in deciding etiology of aortic regurgitation that change surgical management of the patient.

| S-EPMC8404607 | biostudies-literature

Surgical management of iatrogenic coronary artery perforations: when percutaneous treatment fails.

Project description:Coronary perforation is a rare complication of percutaneous coronary interventions and a challenging scenario which imposes prompt recognition and treatment. Although it may be successfully managed percutaneously, a surgical treatment may be preferable in some cases. We report the case of a patient with a coronary perforation with initial percutaneous treatment complicated with extravascular implantation of a covered stent and liver laceration, who was succesfully treated by cardiac surgery. This case suggests the importance of the proximity of an onsite cardiac surgery center when complex coronary artery percutaneous interventions are performed in hospitals with offsite surgical support.

| S-EPMC7525394 | biostudies-literature

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