A rare case of right coronary artery dissection during routine left heart catheterization
Noreen Mirza1, Vikramjit Purewal2, Joanna Pater3
1Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA.
Insights
Catheter induced coronary artery dissection (CICAD) is a rare complication of percutaneous coronary intervention (PCI). This case highlights a rare instance of right coronary artery dissection extending to the aortic root, successfully managed with stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) is a standard treatment for coronary revascularization.
- Complications can arise during PCI, including catheter-induced coronary artery dissection (CICAD).
- CICAD is infrequent, with an incidence as low as 0.1%, and extension to the aortic root is even rarer.
Observation:
- A 68-year-old female with multivessel coronary artery disease underwent left heart catheterization.
- During the procedure, catheter-induced dissection of the right coronary artery (RCA) occurred.
- The dissection propagated towards the aortic root, a rare and potentially severe complication.
Findings:
- The catheter-induced RCA dissection with aortic root propagation was diagnosed.
- The patient was treated with stenting to address the dissection.
- A strategy of watchful waiting was employed following the intervention.
Implications:
- Timely recognition and management of CICAD are crucial for optimal patient outcomes.
- Stenting is an effective treatment for managing coronary artery dissections.
- This case underscores the importance of vigilance for rare complications during PCI, even with standard procedures.
Abstract:
Percutaneous coronary intervention (PCI) is an effective method for coronary revascularization, however, alongside its benefits, it can be accompanied by complications. Catheter induced coronary artery dissection (CICAD) is rare and the consequences can be devastating if left untreated. The incidence has been reported to be as low as 0.1%. Also, propagation of the dissection to the aortic root remains uncommon. The mechanism of dissection is related to mechanical injury to the arterial wall during manipulation with the catheter or wire. It may also occur due to injection of contrast, stenting or balloon dilation. Timely recognition is important in these cases to facilitate optimal patient outcomes which is usually accomplished with stenting. Herein, we report a rare case of a 68-year-old female with multivessel coronary artery disease who presented for routine left heart catheterization and developed catheter induced right coronary artery (RCA) dissection with propagation towards the aortic root which was treated with stenting and watchful waiting.
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