Retrograde dissection during percutaneous coronary intervention: sealing of the entry site by covered stent implantation

Abstract

SummaryWe present a case of iatrogenic aortic haematoma, developed during percutaneous coronary intervention, treated with covered stent implantation followed by a conservative approach characterised by the integration of both clinical and multimodal imaging information. This complication can lead to overt aortic dissection (28-47%), rupture (20-45%) or death (21%). In 10% of the cases it can completely regress. Guidelines for its treatment are debated because of the unpredictable natural history of intramural haematoma. Nowadays, a close follow-up with multimodal imaging is considered a valid strategy for the appropriate management of this severe condition. On the basis of the patient's clinical condition and the information obtained by multiple imaging tests (angiography, transthoracic and transesophageal echocardiography and multidetector CT scan) we decided to treat our patient with medical therapy. To date, a 1-year follow-up negative for cardiac events is recorded. BACKGROUND

Percutaneous coronary intervention in the elderly: current updates and trends

“…Moreover, the integration of clinical and imaging data can assess patients' prognosis and predict their clinical outcomes. It also can define and classify several procedural complications and guide healthcare providers to decide whether to adopt a conservative management strategy or to proceed with more aggressive options [87] . For instance, intra-operative TEE has been used to guide several procedures in the catheterization theater and it provided useful assessments to some age-related PCI complications such as iatrogenic aortic intramural hematomas and helped to assess the patient's outcome and to decide the best management [87] .…”

“…It also can define and classify several procedural complications and guide healthcare providers to decide whether to adopt a conservative management strategy or to proceed with more aggressive options [87] . For instance, intra-operative TEE has been used to guide several procedures in the catheterization theater and it provided useful assessments to some age-related PCI complications such as iatrogenic aortic intramural hematomas and helped to assess the patient's outcome and to decide the best management [87] . Furthermore, with the latest developments of three-dimensional TEE, more accurate intra-operative images of stent scaffolds can be obtained which enabled some investigators to more confidently diagnose and assess some PCI complications like LMCA stent protrusion and migration [88,89] .…”