Iatrogenic Aortocoronary Dissection During Right Coronary Artery Procedures: A Systematic Review of the Published Literature

Management of Catheter-Induced Coronary Artery Dissection Leading to Extensive Bidirectional Intramural Hematoma

Spreading epidemic of atherosclerotic coronary artery disease coupled with huge technical advancement, has led to steep rise in percutaneous coronary interventions. The coronary intervention might be complicated with catheter-induced coronary artery dissection and intramural hematoma. It usually spread antegradely along the course of coronary artery but occasionally retrograde extension into the aorta leads to horrible visual impression. Its size might vary from small to voluminous causing minimum hindrance to complete cessation of flow. Thus, it may manifest as asymptomatic observation to hemodynamic collapse. Quick recognition and prompt bailout stenting of the affected coronary artery is the most common treatment strategy.

Rescue of Iatrogenic Spiral Dissections Using an Intravascular Ultrasound-Guided Parallel Wire Technique

Percutaneous coronary intervention carries a risk of iatrogenic catheter dissection. A spiral aorto-ostial dissection can completely occlude the vessel and cause ischemia with significant hemodynamic compromise. The mortality from such dissections is approximately 6.5%. The situation can be rescued percutaneously by stenting the true lumen open, but this relies on having a wire within the true lumen. Large dissections often have a small true lumen that is hard to wire and a large false lumen that wires easily. There is a paucity of literature outlining the necessary steps to achieve procedural success. This case series includes 2 spiral dissections and demonstrates a step-by-step approach to manage this situation successfully.

Iatrogenic Aortocoronary Dissection During Coronary Intervention: A Case Series

Iatrogenic aortocoronary dissection (IAD) during percutaneous coronary intervention (PCI) is an uncommon and potentially life-threatening complication. Extension of dissection to the ascending aorta, despite early surgical management, carries a high morbidity and mortality risk. Depending on the severity of dissection, the approach to management ranges from monitoring to surgical intervention; more extensive dissections into the ascending aorta, typically more than 40 mm above the coronary ostium, are considered an indication for surgery. We report six cases of IAD, highlighting the critical considerations concerning conservative management. These cases highlight the potential role of individualized management strategies, demonstrating instances where a conservative stance may prove effective in ensuring an optimal patient outcome and the key procedural features essential to optimize outcomes when considering nonsurgical management.