Iatrogenic Coronary Dissection Research Articles

Approach to a patient with iatrogenic coronary dissection during percutaneous intervention

This case report presents a conservative management approach to a potentially hazardous complication, iatrogenic coronary artery dissection (ICAD), occurring during percutaneous coronary intervention (PCI). The patient, a 60-year-old woman with a history of chronic hypertension and type II diabetes mellitus, presented with non-ST-segment elevation myocardial infarction. During the PCI, an antegrade coronary dissection was observed, leading to the termination of the procedure. Post-procedure, the patient was managed conservatively with standard coronary artery disease treatment. Follow-up angiography showed complete healing of the dissection area, and no adverse cardiovascular events occurred during a 3-month follow-up period. This report highlights the importance of early diagnosis and careful management of ICAD. It stresses the need for further research into long-term outcomes and effectiveness of different treatment approaches for patients with ICAD.

Long-term outcomes of periprocedural coronary dissection and perforation for patients undergoing percutaneous coronary intervention in a Japanese multicenter registry

Long-term outcomes of iatrogenic coronary dissection and perforation in patients undergoing percutaneous coronary intervention (PCI) remains under-investigated. We analyzed 8,721 consecutive patients discharged after PCI between 2008 and 2019 from Keio Cardiovascular (KiCS) PCI multicenter prospective registry in the Tokyo metropolitan area. Significant coronary dissection was defined as persistent contrast medium extravasation or spiral or persistent filling defects with complete distal and impaired flow. The primary outcome was a composite of all-cause death, acute coronary syndrome, heart failure, bleeding, stroke requiring admission, and coronary artery bypass grafting two years after discharge. We used a multivariable Cox hazard regression model to assess the effects of these complications. Among the patients, 68 (0.78%) had significant coronary dissections, and 61 (0.70%) had coronary perforations at the index PCI. Patients with significant coronary dissection had higher rates of the primary endpoint and heart failure than those without (25.0% versus 14.3%, P = 0.02; 10.3% versus 4.2%, P = 0.03); there were no significant differences in the primary outcomes between the patients with and without coronary perforation (i.e., primary outcome: 8.2% versus 14.5%, P = 0.23) at the two-year follow-up. After adjustments, patients with coronary dissection had a significantly higher rate of the primary endpoint than those without (HR 1.70, 95% CI 1.02–2.84; P = 0.04), but there was no significant difference in the primary endpoint between the patients with and without coronary perforation (HR 0.51, 95% CI 0.21–1.23; P = 0.13). For patients undergoing PCI, significant coronary dissection was associated with poor long-term outcomes, including heart failure readmission.

Acute Psychological Stress, Coronary Artery Spasm, Iatrogenic Coronary Dissection, In-stent Restenosis, and Atherosclerosis: A Rare Association of Multiple Etiologies for Recurrent Acute Coronary Syndrome

Abstract Nonobstructive coronary artery lesions are seen in two-thirds of patients with angina and verified ischemia using a stress test who undergo coronary angiography. Ischaemia with no obstructed coronary artery disease (INOCA) is becoming more well recognized as a significant medical illness due to its relationship to decreased quality of life and an increased risk of cardiac events. This association between acute coronary syndrome (ACS) and high levels of psychological stress has been thoroughly investigated, and it has been found to be substantial. The microvascular function of the coronary arteries is endothelium-dependent, and this plays a role in how the heart reacts to psychological stress. Although coronary artery spasm (CAS) is likely to play a role in the etiology of INOCA, it is frequently misdiagnosed and underreported. In this article, we discuss a case of a young woman who came with recurrent ACS related to CAS, which was exacerbated by iatrogenic coronary dissection due to the presence of arteria lusoria, an atherosclerotic coronary artery disease leading to in-stent restenosis of the previous stent.

Once in a Blue Moon: Iatrogenic Coronary Dissection in Anomalous Coronary Artery

Coronary anomalies present as a rare phenomenon. One of the most observed coronary anomalies is the single coronary artery (SCA) originating from one coronary ostium and dividing into the coronary arteries in various configurations1Angelini P. Coronary artery anomalies: an entity in search of an identity.Circulation. 2007; 115: 1296-1305Crossref PubMed Scopus (532) Google Scholar, classified by Lipton’s Classification.2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (414) Google Scholar A 38-year-old male patient was admitted to a community hospital with typical signs of non-ST-elevation myocardial infarction (NSTEMI) but without any known comorbidities. Urgent coronary angiography revealed a rare anomaly (incidence of 0.008%3Yamanaka O. Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.Cathet Cardiovasc Diagn. 1990; 21: 28-40Crossref PubMed Google Scholar,4Mohanty A. Chandra S. A rare case of 'superdominant' single coronary artery.Indian Heart J. 2015; 67: 389-391Abstract Full Text Full Text PDF Google Scholar) of an SCA with the left coronary system originating from the right coronary periphery, posterior to the great vessels (Lipton’s Classification R-IP, table 1) and occlusion of the circumflex artery (CX) (figure 1a-b, video 1). A culprit-lesion percutaneous coronary intervention was attempted. However, despite the use of various flexible guidewires and angled microcatheters (90°) CX passage through the left main artery equivalent (LMA) was not achieved (video 2) and resulted in ST elevation. A prompt control demonstrated a dissection of the LMA (figure 1c, video 3). Further interventional approaches were waived and the patient was transferred for surgical revascularization.Table 1Lipton’s Single Coronary Artery Classification2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (414) Google ScholarCodeDescriptionOstial LocationRRight Sinus of ValsalvaLLeft Sinus of ValsalvaAnatomical DistributionIThe solitary domain vessel follows the course of either a normal right or left coronary arteryIIOne coronary artery arises from the proximal part of the normally located other coronary arteryIIILAD and CX arise separately from a common trunk originating from the right sinus of ValsalvaCourse of the Transverse TrunkAAnterior to the great vesselsBBetween the aorta and the pulmonary arteriesPPosterior to the great vesselsSSeptal Type: A part of the route passes through the interventricular septumCCombined Type: Combination of diverse routes Open table in a new tab Intraoperatively, coronary dissection could be confirmed, whereas the left anterior descending artery (LAD) and CX were identified in the typical locations. Coronary revascularization was performed by anastomosis of the left internal mammary artery to the LAD, and a saphenous vein graft to the CX in perfusion-assisted beating heart technique. The postoperative course remained uneventful and the patient was discharged on the 10th postoperative day. The main issue in SCA persists in the dependency on one system with fatal results in proximal occlusion. Since the overall incidence of coronary anomalies is very low3Yamanaka O. Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.Cathet Cardiovasc Diagn. 1990; 21: 28-40Crossref PubMed Google Scholar, the treatment strategy for acute coronary syndromes in patients with anomalous coronary anatomy remains questionable. In particular, an interventional approach in complex coronary anatomy can result in coronary injury. Since in cases of myocardial infarction time matters most, a deep – even inter-hospital – heart team approach is crucial to maintain in-time life-saving treatments. •Lipton’s Classification R-IP is the rarest form of single coronary artery configuration with the left coronary system originating from the right coronary periphery.•Percutaneous coronary intervention of the left coronary system may be very challenging in Lipton’s Classification R-IP•Surgical revascularization is a reasonable strategy in particular when the coronary periphery location is in typical location.•A deep heart team approach is crucial to maintain in-time life-saving treatments in such critical and complex cases. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1ZWIwZTk5NTRiZWEzMDA2MGVlNzI5MmM4OTZjNDlmYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc2MjA3NTg4fQ.My1bJvayG27S7R8PKVtQsWVd9XLKhwldpsEWqzuMHIzYxOz_VIFRiJulyjzbngC4CyNUqZMU_qmU-_r_3QPgVbNU2xkwNmcDVsxgXDGD3oSMx3rmyXQK-bNXjlY-qh_YzCrTQ4UEB8jH1qiVcNVpHyrGc-MtRjc7v89p3xEBD1aa_Ns-xk1OOfXUrdGlF9O7EQX7iWrHtaVkLbdCUhgxc55eQP4YI97gKqxSTzFKe4nOdxPc5K41oBsMkajdNYt83O5oDph59QzDCmbWJJDlinjzvGQqRFcavZjX7emVYeuqr5DOGxgmXTA36j331owW-wzHpdKn7wy_SAu2l1u30g Download .mp4 (3.49 MB) Help with .mp4 files eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIzYjhkMDgxYzg2OTRiYTM0MDZmYTgyZDcyYzcxMmI1NyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc2MjA3NTg4fQ.gH37xsv4GXLcsKMdb-SAuac7Xh_CpCm5C0UOpTzC6x5WB68zYxcjtSgpUhdMHve6TUbPHbeu4gyaKxxZOZFAyXhaMk3R4CzuIFQGSdNyQ3UbqN2MXekQOyGM0i6FNEiLMnWIlxCoQlwOvXWyQ1sI5cKCz5qIkr0f6r_5o2C3gv15nrn3mBIX3vPynprGA_1gHGfLtCQXAvMvVUwYfg-Ba-GOjt1NTSJ0ccCjlQefWR_6jSDTk7NX3BfZ5jU-ybtSzeAxEfALNpfSP2YHm960AaPVaXDNtI0CYb5bkGWLepuD3vzkGAahQrf2K23VUEfho5FELp_CpUVjx4EUMLZ3gA Download .mp4 (1.48 MB) Help with .mp4 files eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2MTc2OTE5MTY2ZDM1OTQ1NTUzYTQ3MzcwOTc1OWJlNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc2MjA3NTg4fQ.G5pvhhPUt-Kl_kxjdKfL-lOu-rH4hRhKzFlVwwANSrmNUjBoRc_thtwNvFupLmPpm1meakrWBTvBZ-JrBLOAlq6fW3AXl46Qy5drW5RxsehHs52zYd8GMPUQ9Trimxz6LG5NH50cVzlCWKi_iaZKUGpRueErVe1WFrp0YqXxkauvv-qmuoIW2pTQS1IpP-6E3u_z8OpKdj53TlaNfpGQJq3z28Uqw5FsY44sS9OP0k_A6uhflBqSRFLKU22pDTS3TPOUSqoxJAATd7yxU-H9QckIiu6lEHsAS2AKowXlAZiXHJnAcRaOBWAFkXx7eJ-MkLy7Eqms1glQNP6hxmoK4Q Download .mp4 (0.95 MB) Help with .mp4 files

Percutaneous coronary intervention for true bifurcation lesions: a single-center experience including the setting of acute coronary syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous coronary intervention (PCI) for true coronary bifurcation lesions is challenging. Purpose To describe procedural and clinical outcomes of true bifurcation PCI. Methods Single-center retrospective study of consecutive patients (pts) submitted to PCI for true bifurcation lesions (06/2018-06/2020). MACE comprised death, myocardial infarction (MI), stroke, restenosis and reintervention. Results During the study period, 1678 PCI were performed, of which 7% were for true bifurcation lesions (Medina x,x,1). 118 pts (mean age 66.4 ± 11.0 years; 74.6% male; 32.2% diabetic; mean left ventricular ejection fraction 49.8 ± 8.4%) were included. Most pts (64.7%) were treated in the setting of an acute coronary syndrome (ACS): 26.7% ST-elevation MI, 31.9% non-ST-elevation MI, 6.0% unstable angina. 35.3% were treated for a chronic coronary syndrome. 24.8% of pts presented with 3-vessel disease and 11.1% had a left main (LM) lesion. The most frequently diseased main branch was the left anterior descending artery: 21.2% (68), followed by the left circumflex: 17.8% (21), right coronary artery: 12.7% (15) and LM: 11.9% (14). In terms of bifurcation classification, lesions were mainly Medina 1,1,1 (71.2%), followed by 0,1,1 (13.6%); 1,0,1 (9.2%) and 0,0,1 (5.9%). PCI was mainly performed via radial artery (73.7%). Mean number of stents: 1.4 ± 0.6. Lesions were predominantly treated with single stenting technique (80.3%). Double-stenting was used in 23 (19.7%) pts: TAP was the most used technique (10), followed by culotte (3), crush (2), double kissing crush (2) and T-stent (1). Proximal optimization technique and kissing balloon inflation were performed in 38.1% and 44.9% of cases, respectively. Rotational atherectomy was used in 10.4%. Ventricular support devices were used in 3 pts (1 Impella, 2 intra-aortic balloon pump). Intracoronary imaging was used in 13 pts: intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in 8 and 5 pts, respectively; its use was more frequent in cases of LM PCI (p=.002). OCT was associated with higher contrast doses (350 vs 224 ml, p<.001), with no increase in acute kidney injury incidence (p=.413). Fluoroscopic time (p=.684) and radiation dose (p=.916) did not differ. Side branch occlusion occurred in 5 pts and iatrogenic coronary dissection in 7 pts. At a mean follow-up time of 17.3 ± 8.1 months, MACE and mortality rates were 13.3% and 6.9%. MACE occurred more frequently in pts with LM lesion (p<.001) and less often in cases where complete revascularization was achieved (p=.006). Conclusions True bifurcations represented a relatively small percentage of PCI lesions and were mainly performed in ACS setting. In line with literature, single stenting was the most used technique. MACE rate was globally low and was decreased by complete revascularization. Still, LM bifurcation PCI was associated with increased MACE.

A highly-detailed anatomical study of normal pericardial structures as revealed by in-vivo computed tomography and magnetic resonance images and ex-vivo novel 3D reconstructions from Visible Human Server

AbstractThe pericardial cavity, sinuses, and recesses are frequently depicted on Computed Tomography (CT) and Magnetic Resonance (MR).We here review the normal human pericardial structures as provided by MR imaging of young, healthy subject and CT scans acquired after iatrogenic coronary dissection. We compared such radiological information with cadaveric axial and sagittal sections of the human body provided by the Visible Human Server (VHS), Ecole Polytechnique Federale de Lousanne (EPFL), Switzerland.

Case reports of antegrade and retrograde iatrogenic coronary spiral dissection complicating percutaneous coronary intervention: Keep calm and carry on!

Iatrogenic dissection during PCI represents one of the most fearing complication of interventional cardiology, since abrupt hemodynamic instability and patient compromise may occur related to coronary occlusion. In this emergency situation, different hemodynamic support devices and interventional skills, are needed in order to promptly recover the patient from cardiogenic shock, especially when the left coronary three is involved by the dissection. We report herein two different iatrogenic retrograde, and antegrade dissections, one involving both left anterior descending artery, left circumflex and aortic bulb and the second characterized by abrupt closure of left main associated with severe hemodynamic compromise and ventricular fibrillation storm which required continuous DC shocks, Impella and ECMO devices support to stabilize the patient. Both cases were successfully managed percutaneously. Different techniques and tricks in order to re-open the vessels are described. In case of iatrogenic coronary dissection, a “keep calm and carry on” strategy should be adopted by the interventional cardiologist team in order to solve such dramatic complication.

Provisional versus 2-stent strategies for coronary bifurcations: is a bird in the hand worth two in the bush?

Abstract Background Among all subsets of coronary artery lesions, bifurcations stand out due to high incidence, demanding percutaneous interventions (PCIs) and poor outcomes. Amid the different PCI strategies, the provisional (PS) approach is generally recommended over 2-stent (TS) techniques, but this paradigm has been challenged. Purpose To compare PS with TS for PCI of coronary bifurcation lesions, concerning procedural aspects and both immediate and long-term patient outcomes. Methods Retrospective study encompassing patients consecutively referred to a tertiary interventional cardiology unit for coronary angiography, who were found to have at least 1 native bifurcation lesion. According to operator experience and angiographic features, patients were managed with PS or/(and) TS. Procedural aspects regarding radiological variables, angiographic success and immediate complications were reviewed, as were in-hospital outcomes. Besides, clinical follow-up, by clinic appointment or telephone calling, was performed targeting stent failure, target vessel revascularization (TVR), acute coronary syndromes (ACS), heart failure and mortality. Results From January 2010 to June 2017, 404 patients with 433 bifurcation lesions were included. Median age was 70 (62–77) years and 25.3% were female. Median follow-up was 2 (1–3) years. Chronic angina was the dominant PCI context (61.3%) with 9.7% presenting with ST-segment elevation myocardial infarction (MI). Medina class 1,1,1 was documented in 54.1% and 64.9% of lesions were hailed as true bifurcations. 303 patients underwent PS, whereas 67 were managed with TS, with TAP (43.3%) and mini-crush (34.3%) as the leading techniques. True bifurcations were more frequently approached with TS (p<0.001), whereas PCI context did not influence procedure selection. Fluoroscopy time (p<0.001), radiation dose (p=0.003) and contrast volume (p=0.009) were higher in the TS subgroup. OCT guidance (p=0.039) was also more common with TS. Angiographic success was uniformly high (95.1% for PS and 97% for TS), while procedural complications, including iatrogenic coronary dissections (7.4%, mostly minor) and slow-reflow (3.5%), were homogenously low. Acute kidney injury and type 4a MI occurred in 14.5% and 32.3%, respectively, also with no difference between groups. As for long-term outcomes, stent failure, encompassing both stent thrombosis (1 event) and restenosis (4.2%), occurred more often with TS (p=0.046), with ACS events (9.5%) following the same trend (p=0.08). In turn, rates of TVR (12.5%), heart failure hospitalization (6.2%) and mortality, regardless of its cardiovascular nature, were similar. Conclusion PS outperforms TS during follow-up, particularly due to lower stent failure odds. Thus, this study further supports the concept of PS as the standard approach for coronary bifurcation lesions. Funding Acknowledgement Type of funding source: None

Women With Spontaneous Coronary Artery Dissection Are at Increased Risk of Iatrogenic Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of acute coronary syndrome (ACS) that affects women disproportionately. Previous case series have found that patients with SCAD undergoing cardiac catheterisation have high rates of iatrogenic coronary damage. We formally compared the rate of iatrogenic coronary artery dissection in women with and without SCAD undergoing cardiac catheterisation over a 11-year period. Women with SCAD were identified by a search of the cardiac catheterisation database 2007-2017 for the keywords 'SCAD', 'spontaneous coronary artery dissection', 'spontaneous coronary dissection', and 'spontaneous dissection'. For each identified case, the medical record and the coronary angiogram images were reviewed to confirm spontaneous coronary dissection. For cases of recurrent SCAD, duplicates were removed so that each patient was included only once in this analysis. For each identified case of SCAD, a control case was chosen from women aged <70 years, without SCAD, undergoing cardiac catheterisation for an ACS during the same 10-year period. One control case was chosen to match each SCAD patient as closely as possible for age and year of cardiac catheterisation. Iatrogenic coronary dissection was defined as new, proximal, flow limiting coronary artery dissection in a different coronary segment to the presenting spontaneous coronary dissection. Eighty-five (85) cases of women with SCAD were identified. Mean age was not different between SCAD and non-SCAD women (51±11 and 51±10 years, respectively). The SCAD group had lower rates of ST elevation myocardial infarction, lower rises in serum creatine kinase (CK) and troponin levels, lower rates of diabetes and smoking, and far less placement of stents during the procedure than the control group. The rate of additional iatrogenic dissection relating to the cardiac catheterisation procedure was 4 of 85 (4.7%) versus 0 of 85 (0%), p=0.04 in SCAD and control groups, respectively, despite a much lower rate of percutaneous coronary intervention in the SCAD group. No common factors could be identified regarding particular equipment or procedural factors associated with iatrogenic dissection. The rate of iatrogenic dissection in women with SCAD during cardiac catheterisation is confirmed to be high and significantly higher than a contemporaneous age-matched group of women without SCAD. This observation likely indicates generalised coronary fragility in this disease, and emphasises the importance of the utmost care in the engagement, injection and intervention involving the coronary arteries in this disease. Development of a non-invasive coronary imaging modality or biomarker able to diagnose SCAD non-invasively would be a great advance in the care of patients with this condition, because it would avoid the need for invasive coronary angiography for diagnosis.

Successful bailout T-stenting for iatrogenic coronary dissection involving left main stem bifurcation: "first, do no harm".

Successful bailout T-stenting for iatrogenic coronary dissection involving left main stem bifurcation: "first, do no harm".

Delayed presentation of left main coronary artery dissection due to catheter ablation in a patient with bicuspid aortic valve. Coincidence or manifestation of inherent vulnerability?

Left main coronary artery (LMCA) injury is an uncommon complication of catheter ablation. Due to the large myocardial area at risk, its presentation is usually acute with a dramatic course and life-threatening sequelae. Increased susceptibility to spontaneous coronary artery dissection has recently been implied in patients with bicuspid aortic valve (BAV). We present the first case of iatrogenic coronary dissection in a BAV patient, with an atypically delayed manifestation. The patient sustained ablation catheter-induced mechanical damage of LMCA due to its inadvertent penetration during the attempts to cross the aortic valve. After three days of recurring chest pain, he was readmitted with anterior myocardial infarction and imminent cardiogenic shock, and underwent emergent coronary stenting.Literature review suggests that in BAV inherent susceptibility to both spontaneous and iatrogenic coronary dissection may exist. Therefore, we advocate that in BAV extreme caution should be exercised during electrophysiological procedures involving the coronary artery cannulation for tagging or pace mapping, or when the left ventricle is to be entered retrogradely, and likewise in percutaneous coronary interventions. Such patients may be doubly predisposed to iatrogenic injury; firstly, by more difficult catheter manipulation in the malformed aortic cusps, and secondly, by the underlying vulnerability of coronary ostia.<Learning objective: Arteriopathy in bicuspid aortic valve (BAV) is not limited to the aorta. It is considered a connective tissue disease predisposing to spontaneous coronary artery dissection. This predisposition may also render the patients more vulnerable to iatrogenic dissection.Ablation in the aortic cusps or with the aortic valve crossing, and percutaneous coronary interventions may require special precautions in the BAV population.Physicians attending post-ablation patients should be aware of a delayed coronary artery occlusion risk.>

Safety and Risk of Major Complications With Diagnostic Cardiac Catheterization.

We aim to study the incidence of major complications related to procedure defined as in-hospital death, myocardial infarction, stroke, pericardial effusion or tamponade, percutaneous coronary intervention due to iatrogenic coronary dissection, or unplanned bypass surgery within 72 hours after diagnostic left heart catheterization (LHC; primary end point). Furthermore, all causes of in-hospital death after LHC were adjudicated and reported (secondary end point). Diagnostic LHC procedures (aortic angiography; coronary, including graft, angiography; and left ventricular angiography) from January 1, 2002, through December 31, 2013, were identified using the clinical scheduling system at Mayo Clinic, Rochester, and complications were identified through electronic records. International Classification of Diseases, Ninth Revision billing codes were used. Registration was queried to identify all-cause mortality. All events were reviewed and adjudicated. There were 43 786 diagnostic LHC procedures; 97.3% were coronary angiograms. The mean age of patients was 64.5 years (13.6), and the majority were male (61.5%). Primary end point was seen in 36 (0.082%) procedures or 8.2 of 10 000 LHCs. Combined right sided procedures with LHC did not increase the risk of major complications. Cardiogenic and septic shock, cardiac arrhythmia, and postsurgical complication were the most common causes of in-hospital death after LHC. The overall rates of major complications related to diagnostic cardiac catheterization procedures are extremely rare. The majority of the deaths occurring post-diagnostic LHC procedures were secondary to acute illness rather than directly related to diagnostic procedure.

Successful Percutaneous Treatment of an Acute Left Main Coronary Occlusion Due to Iatrogenic Dissection Extending Into the Ascending Aorta

Iatrogenic coronary dissection extending to the ascending aorta is rare. The best treatment is immediate resolution by the percutaneous approach, sealing the false lumen “entry door”; however, once the dissection is produced, the true lumen may be difficult to find. We present the case of a

TCTAP C-123 Iatrogenic or Spontaneous Coronary Dissection!! That Is the Question.

TCTAP C-123 Iatrogenic or Spontaneous Coronary Dissection!! That Is the Question.

Trends of Incidence, Clinical Presentation, and In-Hospital Mortality Among Women With Acute Myocardial Infarction With or Without Spontaneous Coronary Artery Dissection: A Population-Based Analysis

ObjectivesThe authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD). BackgroundThe clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear. MethodsThe National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed. ResultsAmong 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7 vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8% vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCAD and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non–ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96). ConclusionsWomen presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower rates of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed for SCAD in the setting of non with ST-segment elevation myocardial infarction.

P4285Characteristics, management and long-term follow-up of iatrogenic coronary dissection: a multicenter study

P4285Characteristics, management and long-term follow-up of iatrogenic coronary dissection: a multicenter study

TAP-stenting as bail-out strategy for iatrogenic dissection of left main bifurcation

Iatrogenic coronary dissection is a rare but potentially catastrophic complication of percutaneous coronary intervention. The proximal left anterior descending artery (LAD) dissection may extend into distal left main bifurcation which may further engulf left circumflex artery (LCx). Here, we report a case of a 69-year-old male where dissection at proximal edge of well deployed stent led to total closure of left circumflex artery causing hemodynamic compromise. It was bailed out using T-and-protrusion (TAP) stenting where LAD and LCx were stented using 3.5x12mm and 3x24 mm sirolimus-eluting stent (Yukon Choice, Translumina) respectively. TAP technique is a feasible and reasonable management strategy for immediate bail-out stenting for this lethal complication

Percutaneous Coronary Intervention in Nonagenarians: Prevalence, Indications, Vascular Approach and Mortality at 3 months

Background: Percutaneous coronary intervention (PCI) in nonagenarians has been shown to be feasible, with a high success rate. However, there is paucity of data regarding the prevalence, vascular access, procedural data and mortality after PCI in this population. Methods: All patients aged 90 and older referred to our institution from 2004 to 2014 for coronary angiogram were included in our retrospective study. Clinical and procedural data including vascular access and 3-month mortality rates were obtained for all patients. Results: A total of 26696 PCI were performed over the last 11 years, of which 177 PCI (0.66%) were realized in 167 nonagenarians. The prevalence of PCI in nonagenarians increased from 0.17% in 2004 to 1.22% in 2014. In this population, with an age of 92 ± 2 years and 51.4% of males, 76 (43%) PCI were performed in the setting of ST-elevation myocardial infarction, and 89 (50%) of the procedures were non-ST elevation myocardial infarction or unstable angina. Transradial approach (TRA) was used in 76 (43%) and transfemoral approach (TFA) in 101 (57%) procedures. Comparing TRA to TFA, the total fluoroscopic time and contrast volume was similar between the two groups. Overall complications, including cardiogenic shock, iatrogenic coronary dissection, perforation or no reflow phenomenon occurred in 22 of 177 procedures (12.4%). Overall survival rate was 92.8% at 3 months. Conclusion: The majority of the procedures was performed in acute coronary syndrome clinical setting. TRA and TFA were comparable in terms of fluoroscopic time and contrast volume. Overall procedural success rate was high and complication rates were low.

A rare case of iatrogenic retrograde coronary dissection spreading antegradely during coronary angiography: emergency revascularization

A rare case of iatrogenic retrograde coronary dissection spreading antegradely during coronary angiography: emergency revascularization

Bailout left main bioresorbable vascular scaffolding for the treatment of iatrogenic coronary dissection induced by guiding catheter and sticky ABSORB bioresorbable vascular scaffold balloon

Keyword: ABSORB Bioresorbable vascular scaffold Coronary dissection Sticky balloon Left main scaffolding Bailout the deployment of a 2.5 × 28 mm BVS (Fig. 1B–D). As the BVS balloon was withdrawn, the EBU guiding catheter (GC) jumped in. Subsequently the patient developed mild chest pain. There was angiographic haziness at the region of distal LM-ostial LAD (Fig. 1E). The operator elected to treat the suspected coronary dissection with a BVS. A 3.0 × 28 mm BVS was positioned from the mid LM and minimally overlapped with the mid LAD BVS (Fig. 1F). It was further optimized with a 3.5 × 12 mm non-compliant balloon. The chest pain subsided and there was good angiographic result of the BVS scaffolding from the LM to the mid LAD (Fig. 1G). For the second case, there was a 62-year-old man, who was an exsmoker with hypertension, hypercholesterolemia and chronic total oc-