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Iatrogenic aortic dissection of the descending aorta after percutaneous coronary intervention

Kristen Westenfield1, Shannon Mackey-Bojack2, Yale L Wang3

  • 1Internal Medicine Resident Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA.

The British Journal of Cardiology
|October 10, 2022
PubMed

Insights

Aortic dissection is a rare but serious complication following coronary angiography, particularly in elderly patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This case highlights the risk associated with catheter manipulation during the procedure.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Aortic dissection is a life-threatening condition.
  • Coronary angiography, while diagnostic, carries inherent risks.
  • Transcatheter aortic valve replacement (TAVR) evaluations often involve elderly patients with comorbidities.

Purpose of the Study:

  • To report a rare case of aortic dissection following coronary angiography.
  • To highlight the potential risks in elderly patients undergoing TAVR evaluation.
  • To emphasize the importance of careful catheter manipulation.

Main Methods:

  • A case report of an elderly female patient undergoing coronary angiography.
  • Transesophageal echocardiogram for diagnosis of aortic dissection.
  • Autopsy for confirmation of aortic intimal tear.

Main Results:

  • The patient developed a descending aortic dissection post-coronary angiogram.
  • Autopsy confirmed an acute intimal tear in the descending aorta.
  • Catheter manipulation was identified as the likely cause.

Conclusions:

  • Elderly patients with atherosclerosis undergoing TAVR evaluation are at increased risk for aortic dissection after cardiac catheterization.
  • Coronary angiography can precipitate aortic dissection.
  • Vigilance and meticulous technique are crucial during cardiac catheterization in high-risk patients.

Keywords:
aortic dissectioniatrogenic aortic dissectionpercutaneous interventiontransthoracic aortic valve replacement

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