Abstract
Successful Transcatheter Aortic Valve Replacement After Iatrogenic Aortic Cusp Dissection After Treatment of Complex, Unprotected Left Main Bifurcation Coronary Artery Disease
Highlights
We present a case of an elderly female with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) after complex intervention of heavily calcified multi-vessel coronary artery disease involving the left main and bifurcation with high-risk Impella protected rotational atherectomy and culotte stenting complicated by left coronary cusp dissection and was managed conservatively without long-term sequelae
Iatrogenic aortic dissection at the time of percutaneous intervention (PCI) is an uncommon complication, occurring at an overall frequency ranging from 0.03% to 1.9% and is typically due to trauma from guide catheters, high pressure balloon inflations, atherectomy, or hydraulic force of contrast injections[2,3,4,5]
While the overall mortality for this complication is reported to be between 50-80%, those presenting with acute coronary syndrome have the highest mortality possibly related to aggressive antithrombotic agents and anticoagulation, along with a profound pro-inflammatory state[6,7]
Summary
Aortic dissection is a rare, albeit potentially fatal complication related to percutaneous coronary intervention, especially when dealing with heavily calcified coronary disease involving the left main. We present a case of an elderly female with severe aortic stenosis who underwent TAVR after complex intervention of heavily calcified multi-vessel coronary artery disease involving the left main and bifurcation with high-risk Impella protected rotational atherectomy and culotte stenting complicated by left coronary cusp dissection and was managed conservatively without long-term sequelae.
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