Aortocoronary dissection during percutaneous coronary interventions for chronic total occlusion: Insights from the
Spyridon Kostantinis1, Athanasios Rempakos1, Bahadir Simsek1
1Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Aortocoronary dissection is a rare (0.2%) complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Most cases were successfully treated with ostial stenting, avoiding emergency surgery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Aortocoronary dissection is a serious complication during percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
- Understanding its incidence, mechanisms, and outcomes is crucial for managing this risk.
Purpose of the Study:
- To investigate the incidence, mechanisms, treatment strategies, and clinical outcomes of aortocoronary dissection in a large cohort undergoing CTO PCI.
- To identify factors associated with aortocoronary dissection and evaluate treatment effectiveness.
Main Methods:
- Analysis of 12,117 CTO PCI procedures from a multicenter registry (2012-2022).
- Comparison of patient characteristics, procedural approaches, and outcomes between cases with and without aortocoronary dissection.
- Evaluation of treatment strategies including ostial stenting and conservative management.
Main Results:
- Aortocoronary dissection occurred in 0.2% of CTO PCI cases (n=27), predominantly in the right coronary artery.
- Patients with dissection had lower technical and procedural success rates but similar in-hospital major adverse cardiovascular events.
- The retrograde approach was more frequent in dissection cases; ostial stenting was the primary treatment, with no emergency surgeries required.
Conclusions:
- Aortocoronary dissection is an infrequent but significant complication of CTO PCI, associated with reduced procedural success.
- Ostial stenting is an effective treatment, and emergency surgery is typically not needed.
- Experienced operators performing CTO PCI can manage this complication effectively.
Background:
Aortocoronary dissection is a potentially serious complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods:
We examined the incidence, mechanisms, treatment, and outcomes of aortocoronary dissection among 12,117 CTO PCIs performed between 2012 and 2022 in a large multicenter CTO PCI registry.
Results:
The incidence of aortocoronary dissection was 0.2% (n = 27). Most aortocoronary dissections occurred in the right coronary artery (96.3%, n = 26). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar, except for dyslipidemia, which was less common in patients with aortocoronary dissection (70.4% vs. 86.0%; p = 0.019). The retrograde approach was used more commonly among cases complicated by aortocoronary dissection (59.3% vs. 31.0%; p = 0.002). Technical (74.1% vs. 86.6%; p = 0.049) and procedural (70.4% vs. 85.2%; p = 0.031) success rates were lower among aortocoronary dissection cases, with a similar incidence of in-hospital major adverse cardiovascular events (3.7% vs. 2.0%; p = 0.541). Of the 27 patients with aortocoronary dissection, 19 (70.4%) were treated with ostial stenting and 8 (29.6%) were treated conservatively without subsequent adverse clinical outcomes. No patients required emergency surgery. Follow-up was available for 22 patients (81.5%): during a mean follow up of 767 (±562) days, the incidence of in-stent restenosis was 11.1% (n = 3).
Conclusions:
Aortocoronary dissection occurred in 0.2% of CTO PCIs performed by experienced operators, was associated with lower technical and procedural success, and was treated most commonly with ostial stenting. None of the patients required emergency cardiac surgery.
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