Related Experiment Video
Updated: Jul 15, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Incidence, treatment and outcomes of coronary artery dissection during percutaneous coronary intervention
Elizabeth Page, Spyridon Kostantinis, Judit Karacsonyi
1Director of the Center for Complex Coronary Interventions, Minneapolis Heart Institute, Chairman of the Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, 920 E 28th Street #300, Minneapolis, Minnesota 55407. esbrilakis@gmail.com.
Insights
Coronary artery dissection, a complication of percutaneous coronary intervention (PCI), occurs infrequently but carries significant risks. This study details its characteristics and adverse outcomes, including death and myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery dissection is a serious complication during percutaneous coronary intervention (PCI).
- Understanding its incidence, causes, and outcomes is crucial for patient management.
Purpose of the Study:
- To analyze the clinical, angiographic, and procedural factors associated with coronary artery dissection post-PCI.
- To evaluate the outcomes and complications of coronary artery dissection.
Main Methods:
- Retrospective analysis of 10,278 PCIs performed between 2014 and 2019.
- Examined patient demographics, vessel characteristics, dissection causes, treatment strategies, and clinical outcomes.
- Assessed in-hospital and long-term adverse events, including mortality and target lesion revascularization.
Main Results:
- Unplanned coronary dissection occurred in 1.4% of PCIs.
- Guidewire advancement was the most common cause (30%), followed by stenting (22%).
- In-hospital major adverse cardiovascular events were 23%, including 7% mortality and 9% acute myocardial infarction; long-term mortality was 20%.
Conclusions:
- Coronary artery dissection is an uncommon but significant complication of PCI.
- It is associated with substantial adverse clinical outcomes, including increased mortality and myocardial infarction.
Background:
Coronary artery dissection is a feared and potentially life-threatening complication of percutaneous coronary intervention (PCI).
Methods:
We examined the clinical, angiographic, and procedural characteristics, and outcomes of coronary dissection at a tertiary care institution.
Results:
Between 2014 and 2019, unplanned coronary dissection occurred in 141 of 10,278 PCIs (1.4%). Median patient age was 68 (60, 78) years, 68% were men, and 83% had hypertension. The prevalence of diabetes (29%), and prior PCI (37%) was high. Most target vessels were significantly diseased: 48% had moderate/severe tortuosity and 62% had moderate/severe calcification. The most common cause of dissection was guidewire advancement (30%), followed by stenting (22%), balloon angioplasty (20%), and guide-catheter engagement (18%). TIMI flow was 0 in 33% and 1-2 in 41% of cases. Intravascular imaging was used in 17% of the cases. Stenting was used to treat the dissection in 73% of patients. There was no consequence of dissection in 43% of patients. Technical and procedural success was 65% and 55%, respectively. In-hospital major adverse cardiovascular events occurred in 23% of patients: 13 (9%) had an acute myocardial infarction (MI), 3 (2%) had emergency coronary artery bypass graft surgery, and 10 (7%) died. During a mean follow up of 1612 days, 28 (20%) patients died, and the rate of target lesion revascularization was 11.3% (n=16).
Conclusion:
Coronary artery dissection is an infrequent complication of PCI, but is associated with adverse clinical outcomes, such as death and acute MI.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:30Acute Coronary Syndrome I: Introduction