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Conservative Management of Extensive Iatrogenic Aortic Dissection
Derrick Y Tam1, Amine Mazine1, Asim N Cheema2
1Divisions of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Aorta (Stamford, Conn.)
|May 19, 2017
Summary
Iatrogenic aortic dissection (IAD) after percutaneous coronary intervention (PCI) can be extensive. This case report suggests conservative management may be a viable option for select patients with extensive IAD.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Iatrogenic aortic dissection (IAD) is a rare but serious complication of percutaneous coronary interventions (PCI).
- Current management guidelines for IAD are lacking, with limited data available.
- Existing evidence suggests surgical intervention for extensive dissections, while limited dissections may be managed conservatively.
Observation:
- A 50-year-old woman developed an extensive IAD from the right coronary artery ostium to the aortic root, ascending aorta, and aortic arch following PCI for ST-elevation myocardial infarction.
- The patient's extensive dissection extended significantly, involving multiple aortic segments.
Findings:
- Despite the extent of the dissection and the general recommendation for surgical management in such cases, the patient was successfully treated conservatively.
- Short-term computed tomography imaging confirmed complete resolution of the dissection under conservative management.
Implications:
- This case challenges the conventional approach, suggesting that conservative management might be a feasible alternative for carefully selected patients with extensive IAD.
- Further research and potentially revised guidelines are warranted to explore conservative strategies for extensive IAD.
- This finding could lead to less invasive treatment options for patients experiencing this rare complication.
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