Managed successfully: Iatrogenic aortic dissection during primary percutaneous coronary intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Iatrogenic aortic dissection is a rare, life-threatening complication of primary percutaneous coronary intervention (PCI).
• Prompt recognition and management are crucial for patient outcomes.
• This case highlights a specific instance of dissection during PCI for myocardial infarction.

Observation:

• A 70-year-old female developed an aortic dissection during primary PCI for a left anterior descending artery myocardial infarction.
• The dissection was attributed to manipulation of the extra backup (EBU) guiding catheter.
• The patient experienced a transient cerebrovascular accident on post-procedure day 3.

Findings:

• Conservative management with strict monitoring in the coronary care unit (CCU) was initiated.
• Serial computed tomography angiography (CTA) demonstrated complete resolution of the ascending aortic dissection.
• The patient recovered fully from the cerebrovascular accident.

Implications:

• Conservative management can be effective for select cases of iatrogenic aortic dissection post-PCI.
• Non-invasive imaging like CTA is vital for monitoring dissection resolution.
• This case underscores the importance of careful catheter manipulation during complex PCI procedures.