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Aortic dissection extending from the brachiocephalic artery during transradial coronary catheterization: a case

Kihyun Kim1, Yeon Seong Kim1, Yeongmin Woo1

  • 1Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea.

BMC Cardiovascular Disorders
|September 2, 2020
PubMed

Insights

Iatrogenic acute aortic dissection (AD) from cardiac catheterization, though rare, can be managed conservatively. This case demonstrates successful conservative treatment for extensive AD originating from the brachiocephalic artery, even with initial instability.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Iatrogenic acute aortic dissection (AD) is a rare but severe complication of cardiac catheterization.
  • Conservative management is possible for retrograde AD or intramural hematoma (IMH) without instability.
  • Limited data exist on the natural course and long-term outcomes of iatrogenic AD.

Observation:

  • A 78-year-old woman developed AD during cardiac catheterization due to a stiff guidewire navigating a tortuous brachiocephalic artery.
  • The dissection extended from the sinuses of Valsalva to the proximal descending aorta.
  • Initial presentation included cardiac tamponade and a thrombosed false lumen, mimicking IMH.

Findings:

  • Despite initial instability and ominous findings, the patient was successfully managed with conservative treatment.
  • The extensive dissection, originating from the brachiocephalic artery during right transradial catheterization, showed a favorable outcome.
  • The thrombosed false lumen on imaging mimicked an intramural hematoma.

Implications:

  • This case highlights the potential for successful conservative management of extensive iatrogenic AD, even with clinical instability.
  • It underscores the importance of careful guidewire manipulation during cardiac catheterization in patients with tortuous vasculature.
  • The long-term outcomes of such conservatively managed cases warrant further investigation.
Abstract

Keywords:
Brachiocephalic trunkCase reportConservative treatmentIatrogenic aortic dissectionTransradial catheterization

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