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Iatrogenic Type A Aortic Dissection Following Percutaneous Coronary Intervention

Hafiz Abdul Manan1, Muhammad Khan2, Muhammad Rafiq3

  • 1Cardiology, Darent Valley Hospital, Dartford, GBR.

Cureus
|December 19, 2024
PubMed

Insights

Iatrogenic aortic dissection during percutaneous coronary intervention is rare but serious. Conservative management may be suitable for stable patients, as demonstrated in this case report.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Iatrogenic type A aortic dissection (IAAD) is a rare, life-threatening complication of percutaneous coronary intervention (PCI).
  • Guidewire manipulation, particularly a loop between the right subclavian and brachiocephalic arteries during coronary angiography via right radial access, can precipitate IAAD.
  • Therapeutic challenges are often associated with managing IAAD.

Observation:

  • A 58-year-old hypertensive female patient developed IAAD during PCI due to guidewire manipulation at the brachiocephalic loop.
  • The dissection extended retrogradely into the ascending aorta.
  • Despite the dissection, the patient remained hemodynamically stable and without myocardial ischemia.

Findings:

  • Conservative management, focusing on strict blood pressure control, was initiated due to the patient's stable condition.
  • Serial computed tomography (CT) imaging confirmed the stabilization of the aortic dissection.
  • The patient subsequently underwent successful PCI via a femoral approach and was discharged the following day.

Implications:

  • This case highlights that conservative management can be a viable option for select patients with IAAD.
  • Individualized treatment strategies are crucial for managing IAAD effectively.
  • Careful guidewire technique during coronary angiography is essential to minimize the risk of IAAD.

Keywords:
acute aortic dissectionanginal symptomsiatrogenic complicationspcipercutaneous coronary intervention

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