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Iatrogenic Aorto-Coronary Dissection: A Rare Complication With Fatal Prognosis
Hema Pamulapati1,2, Siva Sagar Taduru3,2, Pramod Janga4
1Cardiovascular Disease, University of Kanas Medical Center, Kansas City, USA.
Insights
Iatrogenic aorto-coronary dissection (IACD) is a rare but fatal complication following cardiac procedures. This case highlights the severe risks, including sudden death, associated with interventions like PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Iatrogenic aorto-coronary dissection (IACD) is a rare complication of cardiac procedures.
- It carries a high mortality burden and can occur during interventional or surgical interventions.
Observation:
- A 71-year-old female with hypertension and hyperlipidemia presented with anginal symptoms.
- She underwent cardiac catheterization and suffered iatrogenic right coronary artery dissection and ascending aortic dissection.
- This resulted in sudden death.
Findings:
- IACD is a rare complication with a fatal prognosis.
- While coronary angiography and percutaneous coronary intervention (PCI) are generally safe, complications like coronary perforations and iatrogenic aortic dissection (IAD) can occur.
- Coronary injury during PCI, particularly for chronic total occlusions or right coronary artery interventions, can extend to the aortic root.
Implications:
- Iatrogenic aortic dissection (IAD) often has a worse prognosis than spontaneous dissection.
- This case underscores the critical risks associated with cardiac interventions, emphasizing the need for vigilance and advanced management strategies.
- Understanding the mechanisms and risk factors for IACD is crucial for improving patient outcomes.
Abstract:
Iatrogenic aorto-coronary dissection (IACD) is a rare complication of interventional and surgical cardiac procedures, with a very high mortality burden. Here, we report the case of a 71-year-old female with a past medical history of paroxysmal atrial fibrillation, mild to moderate aortic insufficiency, hypertension, and hyperlipidemia, who presented with classic anginal symptoms and underwent a cardiac catheterization, during which she suffered Iatrogenic right coronary artery (RCA) dissection and ascending aortic dissection resulting in sudden death. IACD is a rare complication, with a fatal prognosis. Coronary angiography and percutaneous coronary intervention (PCI) are considered safe, with a low risk of major complications including coronary perforations, and a very low risk of Iatrogenic aortic dissection (IAD). The coronary injury occurs more commonly during PCI of chronic total occlusion (CTO) or RCA interventions and can extend to the aortic root. IAD is often fatal and has worse outcomes than spontaneous dissection.
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