Catheter induced aortocoronary dissection during percutaneous coronary intervention: successful aortoostial stenting

Area of Science:

• Cardiology
• Interventional Cardiology
• Aortic Diseases

Background:

• Iatrogenic acute dissection of the ascending aorta is a rare but serious complication following cardiac catheterization and percutaneous coronary intervention (PCI).
• Ascending aortic dissection (AD) management can be complex, often necessitating surgical repair.
• Aortocoronary dissection (AD) specifically requires tailored treatment strategies.

Observation:

• A 64-year-old female patient underwent PCI for a critical right coronary artery (RCA) lesion.
• The procedure resulted in an iatrogenic acute dissection of the ascending aorta.

Findings:

• Immediate stenting at the origin of the dissection effectively repaired the RCA lesions.
• The stenting also successfully sealed the site of retrograde propagation of the dissection.
• Computed tomography monitoring revealed spontaneous resolution of the ascending aortic dissection within 72 hours.

Implications:

• Percutaneous coronary intervention (PCI) with stenting may be a sufficient treatment for aortocoronary dissection (AD).
• This approach can potentially avoid the need for surgical intervention in select AD cases.
• Non-surgical management with stenting and monitoring can lead to spontaneous repair of ascending aortic dissections.