Aortocoronary Dissection Research Articles

Deep engagement, big trouble: a guide catheter induced aortocoronary dissection during percutaneous coronary intervention.

Deep engagement, big trouble: a guide catheter induced aortocoronary dissection during percutaneous coronary intervention.

Immediate Interventional Management of Aortocoronary Dissection During PCI: A Case Report

Aortocoronary dissection is a rare and potentially fatal complication of percutaneous coronary intervention. It is more common when performing interventions of the right coronary artery or during revascularization of chronic total occlusions. Here, we aimed to provide more data regarding a less common form of this complication. We present the case of an 81-year old woman admitted with an acute infero-lateral myocardial infarction, who was indicated for emergency primary coronary intervention. After revascularization of the left circumflex artery, the left main coronary artery exhibited retrograde dissection into the ascending aorta. This complication was managed with immediate placement of another coronary stent at the left main coronary artery. Further propagation of the dissection was prevented. The patient was discharged in good health with antiagregant and rhythm control therapy for new onset atrial fibrillation. Although retrograde dissection of the left main coronary artery is a very rare complication, it can be successfully managed interventionally.

Iatrogenic aortocoronary dissection of a non-culprit right coronary artery during primary percutaneous coronary intervention in an ST-segment elevation myocardial infarction patient with Turner syndrome.

Samaras, Athanasiosa; Kouparanis, Antoniosb; Didagelos, Matthaiosb; Papadopoulos, Spyridon-Filipposb; Theodoropoulos, Konstantinos C.b; Ziakas, Antoniosb; Kassimis, Georgea,b Author Information

TCTAP C-118 Iatrogenic Aorto-Coronary Dissection of the Right Coronary Artery During Diagnostic Angiography Using a Tiger Catheter

TCTAP C-118 Iatrogenic Aorto-Coronary Dissection of the Right Coronary Artery During Diagnostic Angiography Using a Tiger Catheter

TCTAP C-113 Iatrogenic Aortocoronary Dissection During Emergency Percutaneous Coronary Intervention in a 47-Year-Old STEMI Patient

TCTAP C-113 Iatrogenic Aortocoronary Dissection During Emergency Percutaneous Coronary Intervention in a 47-Year-Old STEMI Patient

Iatrogenic Acute Aortic Dissection Complicating Coronary Catheterization

Abstract Coronary dissection extending to the ascending aorta is an uncommon complication of invasive coronary procedures which carries a life-threatening risk. The performance of percutaneous coronary intervention (PCI) at centers without emergency surgical instruments has increased awareness of potential complications. We report a case of iatrogenic aortocoronary dissection in a patient admitted with acute myocardial infarction (AMI) who was treated during angioplasty. The responsible mechanism for the occurrence of aortic dissection during PCI remains to be discovered. In this case, brisk sealing of the entry site of the dissection with a stent to prevent extension of the aortic dissection appears to be safe and feasible, with good short- and long-term outcomes.

Iatrogenic Acute Aortic Dissection Complicating Coronary Catheterization

Abstract Coronary dissection extending to the ascending aorta is an uncommon complication of invasive coronary procedures which carries a life-threatening risk. The performance of percutaneous coronary intervention (PCI) at centers without emergency surgical instruments has increased awareness of potential complications. We report a case of iatrogenic aortocoronary dissection in a patient admitted with acute myocardial infarction (AMI) who was treated during angioplasty. The responsible mechanism for the occurrence of aortic dissection during PCI remains to be discovered. In this case, brisk sealing of the entry site of the dissection with a stent to prevent extension of the aortic dissection appears to be safe and feasible, with good short- and long-term outcomes.

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

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.

Management and prognosis of catheter induced aortocoronary dissection: A multicentric observational study

Catheter-induced aortocoronary dissection(CIACD) is a rare but potentially devastating complication of percutaneous coronary interventions(PCI). We aimed to assess the incidence, management modalities and in-hospital outcomes of CIACD. This was a retrospective multicentric observational cohort from the national PCI registry. Dissections were defined using the NHLBI classification. The primary endpoint was the occurrence of in-hospital Major Adverse Cardiovascular Events(MACE): a composite clinical criterion including in-hospital cardiac death(CD), heart failure and post-procedural myocardial infarction(MI). Between 2011 and 2020,75556 PCI were performed. We identified 68 patients(0.09%) with CIACD. The mean age was 60 ± 11 yrs and the sex ratio was 1,7. The radial approach was predominant(58,8%). Judkins left and Judkins right catheters caused CIACD in respectively 33,8% and 35,3% of the population. 6 patients had previously normal coronary arteries. CIACD was located at the left main coronary artery in 55,9%. The majority of CIACD was Type C(39,7%). Associated aortic dissection (AAD) was observed in 6 patients (8,8%). Management modalities consisted mainly of immediate stenting of the dissection(75%), however, 16 operators (23,7%) preferred initial medical treatment. Dissections disappeared in 15 patients. 30% of PCI were performed by fellows. 10 patients (14,7%) presented in-hospital MACE. In hospital CD and post-procedural MI occurred in 4,4% and 7,4% of the population. Multivariate analysis showed that left dominance angiogram HR = 12[1,03-142] P= 0,013, AAD HR = 41[1,13-1555] P = 0,047 and procedure complications HR = 13[1,43-130] P = 0,023 were predictive of In-hospital MACE. The management of CIACD is still challenging. Our study was one of the largest series showing that stenting is the main treatment of CIACD; however selective patients who have been treated medically had a good clinical and angiographic evolution.

A Successful Case of Conservative Management for Iatrogenic Aortocoronary Dissection During Percutaneous Coronary Intervention

A Successful Case of Conservative Management for Iatrogenic Aortocoronary Dissection During Percutaneous Coronary Intervention

Guide catheter tip-induced type-II aortocoronary dissection bailed out by stenting the left main coronary artery

Left main coronary artery dissection induced by the tip of the guide catheter (Razor blade effect) with or without extension into the adjacent aortic wall can result in no flow. It is being a life threatening, complication and must be time timely detected and treated by stenting or surgery. A 59-year-old male patient presented with crescendo angina having a history of stenting to left anterior descending coronary artery (LAD) using 3 mm × 23 mm drug-eluting stent 5 years back. Coronary angiogram revealed 100% instent re-stenosis of the LAD. Left circumflex (LCX) coronary artery had proximal chronic total occlusion with J-CTO score of ≥2. The dominant right coronary artery was normal. LMCA dissection was noticed like an invisible dragon from nowhere after stenting of the proximal LCX followed by abrupt retrograde extension into aorta, resulting in no flow in the left coronary artery. The true lumen of LMCA was re-wired, and timely bailout stenting from LMCA to LCX was performed.

Adverse Events With Intravascular Lithotripsy After Peripheral and Off-Label Coronary Use: A Report From the FDA MAUDE Database.

Currently only the peripheral intravascular lithotripsy (IVL) device is approved for use in the United States. We queried the United States Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database from January 1, 2016 to December 14, 2020 for all reports of adverse events and modes of failure related to the peripheral IVL device, when used for on- and off-label indications. There were 20 reports of use in peripheral artery disease interventions and 3 reports of off-label use in coronary interventions. Device malfunction in 13 of 23 patients (56.5%) was the most common adverse event reported. Partial balloon or catheter dislodgment was the most common mode of IVL device failure in 12 of 20 patients (60%), followed by balloon rupture in 3 of 20 patients (15%). Coronary use was rare, and associated with balloon perforation in 1 of 3 patients, bradycardia in 1 of 3 patients, and aortocoronary dissection in 1 of 3 patients. In summary, IVL use carries risk of complications; hence, continued vigilance and postmarketing monitoring are warranted.

Iatrogenic coronary artery dissection: A surgical perspective

Iatrogenic aortocoronary dissection is a rare but potentially fatal complication of coronary catheterizations. Although the incidence is comparatively low, dissection often leads to procedure failure with increased risk of myocardial infarction and death. Iatrogenic aortocoronary dissection is principally caused by disruption of intima at the ostia of the right or left coronary artery during interventional procedures and appears as luminal filling defects, the persistence of contrast or intimal tear outside the coronary lumen.

Iatrogenic Aortocoronary Dissection: A Life Threatening Complication During Percutaneous Coronary Intervention Requiring Urgent Diagnosis and Treatment

Iatrogenic Aortocoronary Dissection: A Life Threatening Complication During Percutaneous Coronary Intervention Requiring Urgent Diagnosis and Treatment

Sinus Valsalva Dissection with Involvement Right Ostium Artery during PCI Rescue: A Rare Complication

Aorto-coronary dissection is a rare complication that occur during percutaneous coronary intervention, but life threatening. We describe a case of limited iatrogenic dissection of Valsalvae, with ostium right coronary artery, during a PCI rescue perfomed via trans-radial approach and was successfully treated without surgical intervention.

Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report

BackgroundRight coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient’s haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention.Case presentationA 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection.ConclusionsThe polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended.

TCTAP C-150 Inadvertent Aorto-coronary Dissection During PCI- a True Nightmare in Cath Lab

### Patient initials or identifier number MR ### Relevant clinical history and physical exam A 42-years old man presented with effort angina. He was a smoker, hypertensive and dyslipidemic. Cardiovascular and other system examination didn't reveal any significant abnormality. His blood pressure

Localized Aortic Root Dissection Secondary to Contrast Agent Injection: Feasibility of Conservative Follow-up With Echocardiography

Introduction: Iatrogenic aortocoronary dissection (ACD) is a nightmare in interventional cardiology. Although ACD is rarely reported, the real-world prevalence is suspected of being higher due to unreported cases. The right coronary artery (RCA) ostium is involved in the majority of cases, and dissections are usually limited to the aortic sinus in half of the clinical presentations. There are different treatment strategies, including interventional approaches, surgery, and medical follow-up. Immediate stent deployment to the coronary osteum might be a life-saving procedure, and the surgical approach should be preferred in occasions of dissection extension beyond the sino-tubular junctions. Catheter trauma and subintimal progression of guidewires are major causes of ACD occurrence.Case Presentation: Herein presented is a case report of spontaneous ACD observed after contrast injection to the RCA ostium. Approximately 8 cc of radiocontrast agent was injected into the right coronary ostium. Antegrade and retrograde dissections which extended to the distal RCA and aortic root were observed. The right sinus of Valsalva was stained with contrast agent, and the border of the stained area was extended to the sinotubular junction. Medical follow-up was proposed by the heart team. Close follow-up with echocardiographic examination indicated the complete regression of the dissection.Conclusion: The authors consider conservative follow-up with echocardiogaphy rather than computed tomography and/or magnetic resonance to be the most appropriate imaging technique for use with stable patients.

Catheter induced aortocoronary dissection during percutaneous coronary intervention: successful aortoostial stenting

Iatrogenic acute dissection of the ascending aorta is a serious but rare complication of cardiac catheterization and percutaneous coronary intervention (PCI). Although treatment of ascending aortic dissection may require surgical repair, stenting at the origin of the dissection area may be sufficient in aortocoronary dissection (AD) following PCI. Described is the case of a 64-year-old female patient who was treated with PCI for a critical lesion of the right coronary artery (RCA). Immediate stenting at the source of the dissection was sufficient to repair the RCA lesions and successfully seal the site of retrograde propagation of the dissection. The ascending aortic dissection was monitored with computed tomography and the dissection was spontaneously repaired within 72 hours.

Catheter-induced aortocoronary dissection following cardiac catheterization

Catheter-induced aortocoronary dissection following cardiac catheterization