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Iatrogenic Acute Ascending Aortic Dissection with Intramural Hematoma during Coronary Artery Stenting: A Case Report
Mohamad El-Haress1, Hicham Daadaa1, Shima Shahjouei2
1Faculty of Medicine, Beirut Arab University , Beirut , Lebanon.
Insights
Iatrogenic aortic dissection during percutaneous coronary intervention (PCI) is rare but serious. Prompt diagnosis and surgical repair are crucial for survival in extensive cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Iatrogenic aortic dissection during percutaneous coronary intervention (PCI) is a rare, life-threatening complication.
- No established guidelines exist for managing PCI-induced acute aortic dissections.
- Treatment strategies vary, including conservative management for localized dissections and surgery for extensive ones.
Observation:
- A case of a female patient who developed acute ascending aortic dissection (Stanford type A-DeBakey type II) with intramural hematoma during elective percutaneous transluminal coronary angioplasty (PTCA).
- The dissection occurred during PTCA of the right coronary artery and left circumflex artery.
- The patient presented with a "full-blown" dissection requiring immediate intervention.
Findings:
- Emergent surgical repair was performed, including ascending aortic tube grafting.
- Coronary artery bypass grafting and septal myomectomy were also necessary due to a severely hypertrophied cardiac septum.
- The patient achieved a successful recovery without postoperative complications.
Implications:
- Minimizing aggressive instrumentation during PTCA is essential to prevent catheter-induced aortic dissections.
- This case highlights the importance of prompt diagnosis and aggressive management for iatrogenic aortic dissections.
- Further research may be needed to establish specific guidelines for managing this rare complication.
Background:
Iatrogenic acute ascending aortic dissection during percutaneous coronary intervention (PCI) is an exceptionally rare and life-threatening sequel that requires early and accurate diagnosis along with rapid management. No guidelines have yet been established to direct decisions on the different treatment options that can be employed in the setting of acute aortic dissections caused by PCI. However, similar cases have been treated either by intracoronary stenting and conservative management as in localized aortocoronary dissections or by surgical intervention in cases of extensive aortic dissections.
Case Summary:
Hereby, we present a rare case of a female patient who developed "full-blown" acute ascending aortic dissection (Stanford type A-DeBakey type II dissection) with intramural hematoma during an elective percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) and left circumflex artery (LCA). Accordingly, emergent surgical repair of the dissected aorta was performed including grafting of supracoronary ascending aortic tube, along with coronary artery bypass graft placement and septal myomectomy for severely hypertrophied cardiac septum. The patient recovered successfully without any documented postoperative complications.
Conclusion:
It is pivotal to avoid aggressive use of instrumentation during PTCA in order to prevent the potential development of catheter-induced aortic dissection.
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