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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Retrograde dissection during percutaneous coronary intervention: sealing of the entry site by covered stent
Gian Battista Danzi1, Alfonso Campanile, Fabiola B Sozzi
1Department of Cardiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Insights
Aortic hematoma after percutaneous coronary intervention can be serious but may resolve. This case highlights successful conservative management using clinical data and multimodal imaging for a patient with iatrogenic aortic hematoma.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Iatrogenic aortic hematoma is a rare but serious complication of percutaneous coronary intervention (PCI).
- The natural history of intramural hematoma is unpredictable, leading to debated treatment guidelines.
- Complications include aortic dissection, rupture, and death, although spontaneous regression occurs in some cases.
Abstract:
We 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.
