Case reports of antegrade and retrograde iatrogenic coronary spiral dissection complicating percutaneous coronary intervention: Keep calm and carry on!

Riccardo Iorio,Giuseppe Massimo Sangiorgi,Giuseppe Terlizzese,Alessandra Pizzuto,Ernesto Greco

doi:10.15761/jccr.1000165

Abstract

Iatrogenic dissection during PCI represents one of the most fearing complication of interventional cardiology, since abrupt hemodynamic instability and patient compromise may occur related to coronary occlusion. In this emergency situation, different hemodynamic support devices and interventional skills, are needed in order to promptly recover the patient from cardiogenic shock, especially when the left coronary three is involved by the dissection. We report herein two different iatrogenic retrograde, and antegrade dissections, one involving both left anterior descending artery, left circumflex and aortic bulb and the second characterized by abrupt closure of left main associated with severe hemodynamic compromise and ventricular fibrillation storm which required continuous DC shocks, Impella and ECMO devices support to stabilize the patient. Both cases were successfully managed percutaneously. Different techniques and tricks in order to re-open the vessels are described. In case of iatrogenic coronary dissection, a “keep calm and carry on” strategy should be adopted by the interventional cardiologist team in order to solve such dramatic complication.

Highlights

Iatrogenic coronary spiral dissection is a potential complication during coronary angiography or percutaneous coronary intervention (PCI) that can lead to emergency surgical aortic repair, coronary artery bypass graft surgery (CABG) or death
Dunning et al proposed a classification of iatrogenic coronary spiral dissection into 3 grades: type 1, limited to the sinuses of Valsalva; type 2, dissection of the ascending aorta beyond the sinuses but < 4 cm; and type 3, ≥ 4 cm 3
A simplified and practical classification has been proposed, based on the extension of the dissection flap: a localized, without extension into the left anterior descending (LAD) or LCX is defined as type I; extension of from the LM into the LAD or LCX is type II; and extension into the aortic root is classified as type III [9]

Summary

Case Report

Case reports of antegrade and retrograde iatrogenic coronary spiral dissection complicating percutaneous coronary intervention: Keep calm and carry on!.

Introduction

Discussion and conclusion

Findings

Learning points