How should I treat an iatrogenic aortic dissection as a complication of complex PCI?

Wykrzykowska, Joanna J.; Ligthart, Jurgen; Lopez, Nieves Gonzalo; Schultz, Carl; Garcia-Garcia, Hector; Serruys, Patrick W.

doi:10.4244/eijv7i9a176

Cited by 20 publications

(10 citation statements)

References 14 publications

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“…15 However, Park et al 27 reported a good outcome of a CTO patient who experienced aortic dissection involving the entire ascending aorta, successfully managed using a conservative strategy. A more recent case was reported by Wykrzykowska et al, 28 underscoring the strategy consisting of patching up the coronary problem, and "wait and see" in close intervals using CT scan or TEE, if the dissected aortic wall segment will heal. 28 We used such a strategy in Dunning class 1 and 2 patients, and achieved short-and long-term good outcomes (87.5% of our patients).…”

Section: Discussionmentioning

confidence: 90%

“…A more recent case was reported by Wykrzykowska et al, 28 underscoring the strategy consisting of patching up the coronary problem, and "wait and see" in close intervals using CT scan or TEE, if the dissected aortic wall segment will heal. 28 We used such a strategy in Dunning class 1 and 2 patients, and achieved short-and long-term good outcomes (87.5% of our patients). In the absence of autopsy proof, it is not possible to know the real cause of the cardiac death observed in case 7, however, the extension of the dissection or the aortic rupture could be assumed as possible causes of such an outcome.…”

Section: Discussionmentioning

confidence: 90%

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Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Boukhris¹,

Tomasello²,

Marzà³

et al. 2015

Canadian Journal of Cardiology

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 90%

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Boukhris¹,

Tomasello²,

Marzà³

et al. 2015

Canadian Journal of Cardiology

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“…However, if the dissection is extending more than 4 cm above the coronary sinuses, it usually requires surgical management [9]. …”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Ascending Aorta Dissection during Diagnostic Coronary Angiography: Rare but Life-Threatening

Lambelin

Janssens

Haenen

2014

Case Reports in Cardiology

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Dissection of the ascending aorta is a very rare but life-threatening complication during diagnostic angiography. We present a case of an elderly woman who underwent an elective diagnostic coronary angiography, complicated with an iatrogenic ascending aorta dissection that did not involve the coronary arteries but originated 4 cm distal of the aortic valve. The patient developed cardiogenic shock due to acute pericardial tamponade and so immediate, life-saving cardiac surgery with implantation of a supracoronary graft was successfully performed. A biopsy from the excised aorta showed loss of smooth muscle cells and accumulation of basophilic ground substance, clear features of cystic media necrosis. This is believed to be the underlying cause of the dissection besides a nonselective injection of the right coronary artery.

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“…If a coronary artery is involved, frequently as an entry point, that usually is enough to seal the dissection at that spot with a stent (big dissections, flow compromise). 4,6,7,9,10 Otherwise, perhaps it may be advisable to consider early surgical consultation.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the case series, many with a limited number of patients and published several years ago, are difficult to extrapolate to our practice because different accesses are used now, often requiring different materials and different techniques, frequently with the patient on intense antithrombotic treatment. [4][5][6][7] More specifically, in 2000, Dunning et al 4 published a series of 9 patients with extensive coronary dissection to the aorta (0.02% incidence) and proposed a simple classification of 3 grades. Type 1 was the aortic dissection limited to the sinus of Valsalva; a type 2 dissection reached the ascending aorta but was <4 cm; and the type 3 dissection, the worst one, exceeded 4 cm in length.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures

et al. 2015

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Background-Aortic dissection type A is a disease with high mortality. Iatrogenic aortic dissection after interventional procedures is infrequent, and prognostic data are scarce. Our objective was to analyze its incidence, patient profile, and long-term prognosis. Methods and Results-Between 2000 and 2014, we retrospectively analyzed 74 patients with dissection of the ascending aorta. Clinical and procedural data were reviewed, and later, we performed a prospective clinical follow-up by telephone or in the office. The incidence of aortic dissection was 0.06%. Our patients, predominantly male (67.6%), had a mean age of 66.9±10.8 years. With multiple cardiovascular risk factors, the main reason for cardiac catheterization was an acute coronary syndrome (n=54). The complication was detected acutely in all, trying to engage the right coronary artery in 47 and the left main artery in 30 and after other maneuvers in 2, mostly complex therapeutic procedures (78.4%). A coronary artery was involved in 45 patients (60.8%). Thirty-five patients underwent an angioplasty and stent implantation; 3 had cardiac surgery; and 36 were managed conservatively. Two patients died of cardiogenic shock after the dissection. After a median follow-up of 51.2 months (range, 16.4-104.8 months), none of the remaining patients developed complications as a result of the dissection, progression, ischemia, pain, or dissection recurrence. Conclusions-Iatrogenic catheter dissection of the aorta is a rare complication that carries an excellent short-and longterm prognosis with the adoption of a conservative approach. When a coronary artery is involved as an entry point, it usually can be safely sealed with a stent with good long-term outcomes.

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How should I treat an iatrogenic aortic dissection as a complication of complex PCI?

Cited by 20 publications

References 14 publications

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Iatrogenic Ascending Aorta Dissection during Diagnostic Coronary Angiography: Rare but Life-Threatening

Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures

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