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The Usefulness of a Multimodality Approach in a Case of Subtle Iatrogenic Aortic Dissection: Sometimes is Better to

Ignazio Salamone1, Maria Ludovica Carerj1, Ugo Barbaro1

  • 1Departments of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino," Messina, Italy.

Journal of Cardiovascular Echography
|August 9, 2019
PubMed

Insights

This case study details a rare complication during percutaneous transluminal coronary angioplasty (PTCA), involving iatrogenic right coronary artery dissection and aortic dissection. Prompt stenting and conservative management led to successful patient recovery.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Radiology

Background:

  • Primary percutaneous transluminal coronary angioplasty (PTCA) is a standard treatment for ST-elevation myocardial infarction (STEMI).
  • Complications, though rare, can arise during or after interventional procedures.

Observation:

  • A 65-year-old female developed recurrent chest pain and ECG changes suggestive of inferior STEMI 5 hours after primary PTCA for anterior STEMI.
  • Coronary angiography revealed iatrogenic right coronary artery (RCA) dissection with contrast media extravasation from a coronary ostium fissure.
  • Computed tomography angiography (CTA) identified a subtle retrograde aortic dissection in the ascending aorta.

Findings:

  • Spiral dissection of the RCA extending from the ostium to the medium tract was successfully treated with coronary stenting.
  • A small hematoma in the ascending aorta was managed conservatively due to stable clinical conditions.
  • Follow-up CTA and transesophageal echocardiography showed resolution of the aortic hematoma.

Implications:

  • This case highlights the importance of recognizing and managing rare iatrogenic coronary artery dissections during PTCA.
  • It underscores the potential for retrograde aortic dissection as a complication of coronary interventions.
  • Conservative management can be effective for subtle aortic dissections following successful coronary artery repair.

Keywords:
Aortic intramural hematomacomputed tomography angiographycoronary artery dissectiontransesophageal echocardiography

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