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Aortic and coronary artery dissection during percutaneous coronary intervention: a case report and review article
Mikail Yarlioglues1, Kutay Tasdemir, Mehmet Gungor Kaya
1Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey. drmikailyar@gmail.com
Insights
Coronary artery dissection, a rare complication of percutaneous coronary intervention, occurred after misdiagnosed coronary spasm. Surgical repair was successful, highlighting the need for vigilant cardiothoracic monitoring.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous coronary interventions (PCI) carry risks, including coronary artery dissection.
- Coronary artery spasm can mimic obstructive lesions, complicating diagnosis during angiography.
Observation:
- A 53-year-old female presented with right coronary spasm, initially mistaken for a lesion.
- Nitrate administration resolved the spasm, but proximal coronary dissection ensued during angiography.
- Dissection progressed anterograde, causing myocardial infarction and hemodynamic compromise due to right coronary artery occlusion.
Findings:
- Anterograde dissection extended retrograde across the aortic truncus.
- Failed percutaneous intervention necessitated surgical management.
- Ascending aortic grafting and coronary bypass surgery were performed successfully.
Implications:
- This case underscores the critical importance of recognizing and managing coronary artery dissection, even when initially presenting as spasm.
- Prompt surgical intervention is vital for complex dissections extending beyond the coronary arteries.
- Continuous cardiothoracic observation is essential for optimal patient outcomes following PCI complications.
Abstract:
Coronary artery dissection is an uncommon but potentially serious complication in percutaneous coronary interventions. We treated a 53-year-old female patient with right coronary spasm, which was misdiagnosed as a coronary lesion. The coronary spasm resolved with nitrate administration, but proximal coronary dissection developed during angiography. It progressed anterograde and led to inferior myocardial infarction and severe hemodynamic instability due to right coronary artery occlusion. Percutaneous intervention failed, and it was determined that coronary dissection progressed retrograde, across the truncus of the aorta. Ascending aortic grafting and coronary bypass surgery were performed. The patient recovered and was discharged after 10 days. Close cardiothoracic observation is mandatory in patient evaluation and management.
