Successful Aorta-osteal Stenting after Iatrogenic Acute Type-A Aortic Dissection during Primary Percutaneous Coronary Intervention

Abstract

Background: Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. This complication, if not managed urgently, can have critical results. Case Report: We present the case of a 70 year-old woman who was treated by primary percutaneous coronary intervention (PCI) of the right coronary artery (RCA) for acute inferior myocardial infarction; however, the procedure was complicated by anterograde dissection of the RCA with a simultaneous retrograde propagation to the proximal part of the ascending aorta. Successful stenting of the entry point was able to heal the RCA and restrict the retrograde propagation to the ascending aorta. The aortic dissection was monitored by means of computerised tomography and the dissection repaired itself spontaneously within a day. Conclusion: Treatment of the aorta coronary dissection (ACD) by urgent osteal stenting is a less invasive treatment compared with surgical treatment in appropriate cases. We demonstrated that immediate osteal stenting should be performed in ACD

Keywords

• Acute myocardial infarction, aorto-coronary dissection, percutaneous coronary intervention

Kaynakça

1. 1. Perez-Castellano N, Garcia-Fernandez MA, Garcia EJ, Delcan JL. Dissection of the aortic sinus of Valsalva complicating coronary catheterization: Cause, mechanism, evolution, and management. Cathet Cardiovasc Diagn 1998;43:273-9.[CrossRef]
2. 2. Carstensen S, Ward MR. Iatrogenic aorto coronary dissection: The case for immediate aorto ostial stenting. Heart Lung Circ 2008;17:325-9. [CrossRef]
3. 3. Dunning DW, Kahn JK, Hawkins ET, O’Neill WW. Iatrogenic coronary artery dissection extending into and involving the aortic root. Cathet Cardiovasc Interv 2000;51:387-93.[CrossRef]
4. 4. Pande AK, Gosselin G, Leclerc Y, Leung TK. Aortic dissection complicating coronary angioplasty in cystic medial necrosis. Am Heart J 1996;131:1221-3.[CrossRef]
5. 5. Goldstein JA, Casserly IP, Katsiyiannis WT, Lasala JM, Taniuchi M. Aortocoronary dissection complicating a percutaneous coronary intervention. J Invasive Cardiol 2003;15:89-92.
6. 6. López-Mínguez JR, Climent V, Yen-Ho S, Gonzales-Fernandez R, Nogales-Asensio JM, Sanchex-Quintana D. Caracteristicas estructurales de los senos de Valsalva y porcion proximal delas arterias coronarias. Su relevancia durante la diseccion retrograde aortocoronaria. Rev Esp Cardiol 2006;59:696-702.[CrossRef]
7. 7. Yip HK, Wu CJ, Yeh KH, Hang CL, Fang CY, Hesieh YK, et al. Unusual complication of retrograde dissection to the coronary sinus of Valsalva during percutaneous revascularization: a single-center experience and literatüre review. Chest 2001;119:493-501.[CrossRef]
8. 8. Tanasie C, Chandonnet M, Chin A, Kokis A, Ly H, Perrault LP, et al. Catheter-induced aortic dissection after invasive coronary angiography: evaluation with MDCT. AJR Am J Roentgenol 2011;197: 1335-40. [CrossRef]

9. 9. Kim JY, Yoon J, Jung HS, Yoo BS, Lee SH. Percutaneous coronary stenting in guide-induced aortocoronary dissection: angiographic and CT findings. Int J Cardiovasc Imaging 2005;21:375-8.[CrossRef