Abstract
BackgroundIatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. Also rare is spontaneous coronary artery dissection (SCAD), a form of acute coronary syndrome, which develops in relatively young women without coronary risk factors. We encountered type A iatrogenic AAD caused by an intervention for SCAD.Case presentationA 53-year-old woman was brought to our hospital after cardiopulmonary resuscitation. She was diagnosed with acute coronary syndrome caused by SCAD, and percutaneous coronary intervention was carried out on her distal left anterior descending artery. The dissection proceeded to the proximal left anterior descending artery and left main coronary artery trunk, so additional percutaneous coronary intervention was performed on the left circumflex artery. After the intervention, type A AAD occurred with a primary entry tear from the left main coronary artery trunk, and computed tomography showed a type A AAD of the aortic arch. We performed emergency ascending aorta replacement and coronary artery bypass grafting to the left anterior descending artery and left circumflex artery. The patient had an uneventful recovery after the operation and was discharged on postoperative day 25.ConclusionTo our knowledge, this is the first report of an iatrogenic AAD caused by percutaneous coronary intervention for SCAD.
Highlights
Iatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare
We report the rare case of type A Iatrogenic acute aortic dissection (IAAD) caused by coronary intervention for spontaneous coronary artery dissection (SCAD)
Pericardial effusion collection was recognized by transthoracic echocardiography and increased gradually, and computed tomography (CT) showed type A AAD with a primary entry tear from the left main coronary artery trunk (LMT), which had not seen when the patient was arrived at our hospital (Fig. 3)
Summary
Iatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. Background With advancements in cardiovascular interventional techniques and materials, the number of percutaneous coronary intervention (PCI) procedures is increasing, as is the number of patients who receive complex and higher-risk PCIs. Iatrogenic acute aortic dissection (IAAD) is one of the complications of coronary angiography and PCI. Spontaneous coronary artery dissection (SCAD) is a rare form of acute coronary syndrome (ACS) and one of the causes of sudden cardiac death.
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