Rescue of Iatrogenic Spiral Dissections Using an Intravascular Ultrasound-Guided Parallel Wire Technique
Harish Sharma1,2, Arif Khan3, Benjamin Wrigley3
1Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Insights
A spiral aorto-ostial dissection during percutaneous coronary intervention can be fatal. This case series presents a successful step-by-step approach to manage these challenging dissections using stenting.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) can lead to iatrogenic catheter dissections.
- Spiral aorto-ostial dissections pose a significant risk, potentially causing complete vessel occlusion, ischemia, and hemodynamic compromise.
- Mortality associated with these dissections is approximately 6.5%.
Observation:
- Managing large spiral dissections is challenging due to a small true lumen that is difficult to wire, while the false lumen is easily wired.
- A paucity of literature exists detailing successful procedural management strategies.
- This case series includes two patients with spiral dissections.
Findings:
- A step-by-step approach was successfully employed to manage two cases of spiral aorto-ostial dissection.
- The technique focused on navigating and stenting the true lumen, despite initial wiring challenges.
- Procedural success was achieved in both presented cases.
Implications:
- This approach offers a potential strategy for percutaneous rescue of spiral aorto-ostial dissections.
- Successful management can mitigate the high mortality associated with this complication.
- Further studies are warranted to validate this technique in a larger patient cohort.
Abstract:
Percutaneous coronary intervention carries a risk of iatrogenic catheter dissection. A spiral aorto-ostial dissection can completely occlude the vessel and cause ischemia with significant hemodynamic compromise. The mortality from such dissections is approximately 6.5%. The situation can be rescued percutaneously by stenting the true lumen open, but this relies on having a wire within the true lumen. Large dissections often have a small true lumen that is hard to wire and a large false lumen that wires easily. There is a paucity of literature outlining the necessary steps to achieve procedural success. This case series includes 2 spiral dissections and demonstrates a step-by-step approach to manage this situation successfully.
