Concurrent dissections of ascending aorta and right coronary artery during primary coronary angioplasty

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Cardiology

Background:

• Transfemoral primary coronary angioplasty (PCA) is a common intervention for acute myocardial infarction (MI).
• Complications such as coronary artery dissection can occur during PCI procedures.
• Aortic dissection is a serious condition, but its association with coronary artery dissection during angioplasty is rare.

Observation:

• A patient undergoing PCA for acute inferior MI developed a dissection in the right coronary artery (RCA) secondary to balloon inflation.
• This RCA dissection was followed by an accompanying dissection in the ascending aorta (AA).
• An angiographically invisible retro-dissection in the RCA is hypothesized as the cause of the ascending aortic dissection.

Findings:

• Computed tomography (CT) confirmed the ascending aortic dissection, which was localized to the ascending aorta.
• The patient was managed conservatively with medical therapy.
• Follow-up CT five days later showed complete resolution of the false lumen in the ascending aorta, indicating successful healing.

Implications:

• This case highlights a rare complication of coronary angioplasty, involving simultaneous dissection of the ascending aorta and a coronary artery.
• It suggests that even seemingly minor coronary artery dissections can potentially lead to more extensive aortic pathology.
• Conservative management can be effective for contained ascending aortic dissections occurring as a complication of percutaneous coronary intervention.