Retrograde Approach to Manage Acute Coronary Closure Due to Dissection

Iatrogenic coronary artery dissection (ICAD) is an uncommon and serious complication of percutaneous coronary intervention (PCI), occurring in <1% of cases, potentially leading to abrupt vessel closure, myocardial infarction, or death.

We describe a case of ICAD managed successfully using retrograde PCI without visible collateral channels. The patient had an iatrogenic type D dissection of the right coronary artery, treated effectively with this innovative approach.

Retrograde PCI has been reported in cases with ICAD and visible septal collateral channels. However, this case demonstrates feasibility even in their absence, avoiding the need for surgical intervention. This case offers valuable insights into managing complex, life-threatening PCI complications and highlights the importance of procedural adaptability to ensure optimal outcomes.

Gentle contrast injection and meticulous coronary wiring minimize ICAD risk. When it occurs, retrograde bailout stenting is a viable option if antegrade approaches fail, in the absence of visible collateral branches.