Catheter-induced Coronary Artery Dissection Research Articles

A rare case of right coronary artery dissection during routine left heart catheterization

Percutaneous coronary intervention (PCI) is an effective method for coronary revascularization, however, alongside its benefits, it can be accompanied by complications. Catheter induced coronary artery dissection (CICAD) is rare and the consequences can be devastating if left untreated. The incidence has been reported to be as low as 0.1%. Also, propagation of the dissection to the aortic root remains uncommon. The mechanism of dissection is related to mechanical injury to the arterial wall during manipulation with the catheter or wire. It may also occur due to injection of contrast, stenting or balloon dilation. Timely recognition is important in these cases to facilitate optimal patient outcomes which is usually accomplished with stenting. Herein, we report a rare case of a 68-year-old female with multivessel coronary artery disease who presented for routine left heart catheterization and developed catheter induced right coronary artery (RCA) dissection with propagation towards the aortic root which was treated with stenting and watchful waiting.

TCTAP C-105 A Twist in the Story: Iatrogenic Catheter-Induced Coronary Artery Dissection

TCTAP C-105 A Twist in the Story: Iatrogenic Catheter-Induced Coronary Artery Dissection

Association Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection

Association Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection

The bailout left main stenting after diagnostic catheter-induced coronary artery dissection

The bailout left main stenting after diagnostic catheter-induced coronary artery dissection

Autopsy Findings of Coronary Artery Dissection Occurring during Coronary Angiography

The authors present autopsy findings from a case of catheter-induced coronary artery dissection during angiography. This adverse outcome is an uncommon but potentially devastating complication of coronary catheterization. The report will describe the clinical course and autopsy of an elderly woman with multiple comorbidities who had a coronary artery dissection during a coronary angiography procedure.

Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry.

Despite the ever-increasing complexity of percutaneous coronary intervention (PCI), the incidence, predictors, and in-hospital outcomes of catheter-induced coronary artery dissection (CICAD) is not well defined. In addition, there are little data on whether persistent coronary flow impairment after CICAD will affect clinical outcomes. We evaluated 17,225 patients from 15 participating hospitals within the Japanese PCI registry from January 2008 to March 2016. Associations between CICAD and in-hospital adverse cardiovascular events were evaluated using multivariate logistic regression. Outcomes of patients with CICAD with or without postprocedural flow impairment (TIMI flow ≤ 2 or 3, respectively) were analyzed. The population was predominantly male (79.4%; mean age, 68.2 ± 11.0 years); 35.6% underwent PCI for complex lesions (eg. chronic total occlusion or a bifurcation lesion.). CICAD occurred in 185 (1.1%), and its incidence gradually decreased (p < 0.001 for trend); postprocedural flow impairment was observed in 43 (23.2%). Female sex, complex PCI, and target lesion in proximal vessel were independent predictors (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.53–3.10; OR, 2.19; 95% CI, 1.58–3.04; and OR, 1.55; 95% CI, 1.06–2.28, respectively). CICAD was associated with an increased risk of in-hospital adverse events (composite of new-onset cardiogenic shock and new-onset heart failure) regardless of postprocedural flow impairment (OR, 10.9; 95% CI, 5.30–22.6 and OR, 2.27; 95% CI, 1.20–4.27, respectively for flow-impaired and flow-recovered CICAD). In conclusion, CICAD occurred in roughly 1% of PCI cases; female sex, complex PCI, and proximal lesion were its independent risk factors. CICAD was associated with adverse in-hospital cardiovascular events regardless of final flow status. Our data implied that the appropriate selection of PCI was necessary for women with complex lesions.

TCT-752 Transradial Access is Associated With an Increased of Risk Catheter-Induced Coronary Artery Dissection Compared with Transfemoral Access

TCT-752 Transradial Access is Associated With an Increased of Risk Catheter-Induced Coronary Artery Dissection Compared with Transfemoral Access

TCTAP C-043 Successful Bail Out the Catheter-induced Coronary Artery Dissection in Left Main Coronary Artery

### Patient initials or identifier number S. M ### Relevant clinical history and physical exam A-82-year-old Japanese female admitted to our hospital, because she had a repetitive resting chest pain early in the morning. Her coronary risk factor was only hypertension. Because we suspected a

TCTAP C-132 Usefulness of Crusade Catheter Supported Rewiring with Intravascular Ultrasound Guide for the Catheter-induced Coronary Artery Dissection

### Patient initials or identifier number S.Y. ### Relevant clinical history and physical exam The patient was 60’s female. She had been treated with hypertension, dyslipidemia, glucose intolerance and chronic thyroiditis, and was a prior smoker. She had been complaining accelerating chest

TCT-386 Iatrogenic catheter-induced dissection during angiography of patients with spontaneous coronary artery dissection

Iatrogenic catheter-induced coronary artery dissection (ICAD) is a rare (<0.2%) complication of coronary angiography (CA). Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in women and is frequently associated with arterial fragility from predisposing

Catheter-Induced Aortic Dissection After Invasive Coronary Angiography: Evaluation With MDCT

The purpose of this study was to describe the MDCT findings of retrograde aortic extension of catheter-induced coronary artery dissection and the use of MDCT in follow-up of this complication. Coronary artery dissection with aortic extension can be a fatal although infrequent complication. The coronary artery entry point is usually stented in the catheterization laboratory. Thereafter, CT is the imaging modality of choice for immediate confirmation of the presence of residual iatrogenic aortic dissection and evaluation of its extent and later noninvasive follow-up.

Catastrophic Complication of Stent Perforation in a Uremic Patient with Acute Myocardial Infarction

Catheter-induced coronary artery dissection is a rare but devastating complication of coronary angiography and percutaneous coronary intervention (PCI). Complications during PCI include coronary artery dissection, intramural hematoma, coronary artery perforation, and occlusion of branch vessels. Stent perforation is more unusual and potentially fatal. Here, we report a 68-year-old uremic woman who underwent primary PCI for her acute myocardial infarction. Unfortunately, dissection of the left proximal coronary artery by a guide catheter, followed by stent implantation, resulted in stent perforation through the middle left coronary artery and severe laceration of the left coronary orifice. Cardiogenic shock leading to cardiac arrest occurred. Emergency coronary artery bypass grafting and aortomy for left coronary orifice repair were conducted. The patient's postoperative course was uneventful, and she was discharged 15 days after surgery. From the successful outcome in this patient, we speculate that both better selection of patients and lesions for angioplasty and surgical standby may prove to be life-saving and effectively decrease subsequent mortality for patients experiencing devastating complications during PCI.

Large atherosclerotic plaque related severe right coronary artery dissection during coronary angiography

Catheter-induced coronary artery dissection and occlusion is a rare but serious complication of diagnostic cardiac angiography. A 50 year-old man presented with unstable angina. ECG, exceptional of bradycardia, was normal (57 beat/min). Selective coronary angiography demonstrated 98% narrowing in the mid-portion of the left anterior descending coronary artery (LAD). During the right coronary angiography, following catheter manipulation in the vicinity of the aortic valve, the patient complained of severe chest discomfort, and he had electrocardiographic evidence of acute inferior wall myocardial infarction. Right coronary artery (RCA) was free of the significant obstruction, and it was observed to be having a dominant artery with a spiral dissection (NHLBI Grade IV) located between ostium and the proximal portion of the posterior descending and posterolateral artery bifurcation. The patient was immediately operated with off-pump coronary artery bypass surgery. Consequently, iatrogenic right coronary dissection that is a very rare condition as a cause of myocardial infarction, is discussed in this case report.

Imaging of left main trauma during diagnostic cardiac catheterization with intravascular ultrasound.

In this case report the occurrence of a catheter-induced coronary artery dissection is described. In our patient, angiography showed a mushroom-shaped exudate above the left main coronary artery. Intravascular ultrasound revealed a circular dissection with a huge false lumen connected to the true lumen by a small intimal tear. A brief review of the literature on catheter-induced coronary dissection is included. We believe that this case report provides a good illustration of the need for careful reviewing of indications for angiography. Although procedural risks are low, angiography remains an invasive diagnostic test with the potential to cause severe complications.

Coronary occlusion following diagnostic angiography: Salvage by intracoronary stenting

Catheter-induced coronary artery dissection and occlusion is a rare but serious complication of diagnostic cardiac angiography. This report describes the successful management of this complication with an intracoronary stent after prolonged balloon inflations and intracoronary thrombolytic therapy were unsuccessful.