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Management of iatrogenic ascending aortic dissection after percutaneous intervention of chronic total occlusion

Ahmad Safdar1, Laura Young1, Jaikirshan Khatri2

  • 1Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 9, 2024
PubMed

Insights

Iatrogenic ascending aortic dissection is a rare but serious complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Conservative management is often successful, avoiding urgent surgery.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Aortic Complications

Background:

  • Iatrogenic ascending aortic dissection is a rare complication following percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
  • Understanding the incidence and management of this complication is crucial for patient safety.

Purpose of the Study:

  • To highlight the prevalence of iatrogenic ascending aortic dissection after CTO PCI.
  • To review conservative management strategies for this complication.

Main Methods:

  • Retrospective analysis of patients undergoing CTO PCI at a single medical center (2020-2022).
  • Data sourced from the Prospective Global Registry for the Study of CTO database.

Main Results:

  • Six cases of iatrogenic ascending aortic dissection occurred in 318 patients.
  • Causes included guiding catheter trauma, injection techniques, and balloon rupture.
  • Two patients underwent IVUS-guided stenting; all received conservative management with no urgent surgery.

Conclusions:

  • CTO PCI has a higher complication rate, including aortic dissection, than non-CTO PCI.
  • Conservative management is effective for stable patients; formal imaging is recommended.
  • Outcomes for stable coronary disease patients with dissection appear better than in acute coronary syndrome.
Abstract

Keywords:
ANGO ‐ angiography ‐ coronaryAORT ‐ aortaCAD ‐ coronary artery diseaseCTOCTO‐ percutaneous coronary interventionPCIC ‐ percutaneous coronary interventioncomplex PCI

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