Extensive Coronary Dissection Research Articles

Spontaneous coronary artery dissection in the presence of myocardial bridge causing myocardial infarction: an insight into mechanism

Article history: Received 18 December 2015 Accepted 3 January 2016 Available online 7 January 2016 or alcohol abuse as well as history of smoking. Troponin level was normal. Echocardiography showed ejection fraction of 61% with focal ventricular motion abnormality. Coronary angiography was performed. Severe compromise of blood flow in the left anterior descending artery was present. Subsequent optical coherence tomography examination revealed extensive coronary dissection of left anterior descending artery

Diagnostic Efficacy of Coronary CT Angiography as a Follow-up Modality for Procedure-Related Coronary Dissection

Procedure-related coronary dissection is associated with an increased risk of major adverse cardiovascular events after percutaneous coronary intervention (PCI). In most patients with such an iatrogenic complication, further PCI or bypass surgery aimed at complete revascularization is performed. Moreover, conventional coronary angiography has been used as a standard modality in the follow-up of such patients. The present report describes a 70 year old female patient who was complicated by catheter-related extensive coronary dissection in the right coronary artery (RCA) when treated for an acute myocardial infarction. Although RCA flow was insufficient, we decided against revascularization and followed her medically without additional revascularization procedures. Her clinical course had been uneventful for 4 years. However, symptoms of effort angina developed and re-examinations were performed at approximately 5 years after the myocardial infarction. Although conventional coronary angiography failed to show the culprit lesion responsible for the angina symptoms, the superior spatial resolution of the coronary CT angiography clearly identified significant progression of the stenotic lesion in the true lumen of the dissected RCA. Thus, coronary CT angiography might be considered as a possible first-line follow-up modality in patients with procedure-related coronary dissection.

Dissection coronaire extensive compliquant une angioplastie : à propos d’une série de 19 cas consécutifs

Purpose of the study Extensive coronary dissection is a rare complication of intraluminal angioplasty. We report a retrospective study of 19 patients who consulted in a general hospital without cardiac surgery. Patients and methods After consulting our coronarography and angioplasty database, we included the extensive coronary dissections (type D, E and F) in our study. The medical files of the selected patients were analysed. Results Between January 2003 and March 2010, 19 coronary angioplasty (total: 2542) were complicated with extensive dissections (incidence 0,75%). For 62,3% of the patients, the dissection was related to the guiding catheter. Eleven patients had type A and B1 lesions. The dissections affected the right coronary artery for 16 patients, the left anterior descending coronary artery for two patients and the left main coronary artery for one patient. After angioplasty, a final TIMI flow 3 was obtained for only 11 patients. In nine cases, we observed a limited extension to the aorta that did not need a chirurgical intervention and had no influence on the prognosis. The complications were common, such as death ( n = 1), coronary bypass ( n = 2), myocardial infarction ( n = 8), cardiogenic shock ( n = 2) and circulatory assistance ( n = 2). Conclusion Extensive coronary dissection is a rare complication of angioplasty. The right coronary is the most frequent vessel concerned and an extension to aorta is usual. The treatment is usually based on sealing the entry with a coronary stent. The complications are common and serious and we did not find any predicting factors to extensive coronary dissections that are unpredictable.

Unusual Retrograde Aortic Arch Dissection During Percutaneous Coronary Intervention

Coronary dissection is one of the most frequently occurring complications during coronary interventional procedures. However, extensive coronary dissection retrograde to the coronary sinus of Valsalva and to the arch of aorta is very rarely observed. The authors report a case of retrograde coronary dissection extending into the arch of aorta. Management and coronary angiography at 6-month follow-up are discussed.

Extensive coronary dissection treated with endarterectomy and coronary reconstruction

Acute coronary dissection is an uncommon event, usually not related to typical coronary risk factors, usually in women, and usually diagnosed at autopsy. This report describes a young woman with extensive left anterior descending coronary artery (LAD) dissection, refused for intervention since there was no lesion to angioplasty and no artery to bypass. A long arteriotomy was made, removing under direct vision all of the torn and dissected tissue, just as would be done for extensive LAD endarterectomy. A vein was split and attached to reconstruct the artery. Normal left ventricular function was restored.

Unusual Complication of Retrograde Dissection to the Coronary Sinus of Valsalva During Percutaneous Revascularization: A Single-Center Experience and Literature Review

While coronary dissection, which is one of the most frequently occurring complications during interventional procedures, has various forms, extensive coronary dissection retrograde to the coronary sinus of Valsalva (CSV) is very rarely observed. Within the last 5 years, we retrospectively reviewed our experience with 4,700 consecutive patients who underwent angioplasty procedures, 7 of whom (0.15%) developed extensive coronary dissection retrograde to the CSV. Six of the seven patients developed retrograde dissection of the right CSV during angioplasty to the right coronary artery. One of the seven patents developed retrograde dissection of the left CSV during angioplasty to the left anterior descending artery. Retrograde dissection, which extended to the ascending aorta in two patients, was observed by transthoracic echocardiography and surgical findings, respectively. Five patients were successfully treated by coronary stenting. However, this complication caused four patients to have acute myocardial infarctions, resulting in emergency surgery for one patient and in-hospital death for another. Our experience increased our understanding of this very rare complication. However, this complication may be life threatening, and patients in this clinical setting may have a potential risk for acute myocardial infarction, emergency surgery, or even sudden cardiac death. Therefore, it is important to learn how to promptly diagnose and manage this complication.

Pathology of bailout coronary stenting in human beings

Objectives The aim of this study was to perform detailed postmortem analysis of bailout coronary stenting to gain insights into the mechanism of success or failure of the procedure. Bailout stenting is increasingly used for acute or threatened arterial closure after angioplasty. Few pathologic data from bailout stenting have been reported. Methods and Results The coronary arteries from 6 cases of bailout stenting were analyzed at autopsy. All stents were placed for extensive coronary dissection or abrupt vessel closure after balloon angioplasty. Twenty stents (11 Palmaz-Schatz and 9 Gianturco-Roubin stents) were placed in 8 coronary arteries, ranging from 1 to 5 stents per artery. After stenting, angiography showed good coronary flow in 3 of 6 cases. All patients died secondary to acute myocardial infarction. Histologically, in all cases, the stents were well opposed to the coronary artery wall, with a focally widely patent lumen by compression of the dissection plane. However, in 4 of 6 cases, there was residual dissection present in the nonstented portion of the arteries proximal, proximal to, and between stents or distal to the stented segment, resulting in focal luminal compression or obstruction. In 2 cases, bailout stenting effectively covered the dissection and prevented luminal compression. Conclusions Bailout stenting for dissection after balloon angioplasty restores lumen patency in the stented segment. Residual dissection in nonstented segments adversely affects outcome and supports the need for continued development of new stents with increased trackability and tapering designs to more effectively treat major coronary dissections. (Am Heart J 1999;137:621-31.)

Percutaneous transluminal coronary angioplasty in chronic coronary artery occlusion

Objectives. This study was conducted to determine the procedural success rate, complication rate and long-term outcome of percutaneous transluminal coronary angioplasty in chronically occluded coronary arteries.Background. Coronary angioplasty of chronically occluded vessels has a lower success rate than has angioplasty of nonoccluded vessels, but it is frequently considered safe because the target vesse! is already occluded. The purpose of this study was to determine the reliability of these assumptions at our institution, with the objectives stated above.Methods. We identified from the angioplasty data base at our institution 100 consecutive coronary angioplasty procedures performed between 1987 and 1991 for chronic total occlusion, defined as complete occlusion (Thrombolysis in Myocardial Infarction [TIMI] grades 0 and 1 flow) for ≥3 months. The records of the 95 patients who underwent these procedures were reviewed to determine procedural outcome and medium-term results.Results. Procedural success was obtained in 47 occluded vessels (47%). Significantly fewer successes were obtained in the right coronary artery (26.8%) than in either the left anterior descending (57.1%) or the left circumflex (45%) coronary artery (p < 0.05). A procedural failure without serious adverse consequences occurred in 45 procedures (45%), but in eight patients (right coronary artery in five, left anterior descending artery in three) attempted recanalization was complicated by extensive coronary dissection with acute myocardial ischemia, and one of these patients died. There were no emergency operations, but elective coronary artery bypass surgery was undertaken in 26 patients (in 3 after extensive dissection, in 7 after an apparently good result and in 16 in whom the procedure failed). At 12 months after the procedure, 64.1% of those with a procedural success were event free compared with 32.6% of those whose procedure was both unsuccessful and uncomplicated (p < 0.025) and 25% of those in whom it was unsuccessful and complicated by coronary dissection (p < 0.025).Conclusions. In this series of recanalization of chronically occluded coronary arteries, there was a low procedural success rate, particularly for the right coronary artery. However, when procedural success was obtained, the long-term outlook was good. The overall risk of coronary dissection was comparable to the risk in nonoccluded vessels but was particularly high in the right coronary artery (13%).