Management of Aortocoronary Dissection and Intramural Hematoma With Retrograde Approach and Cutting Balloon

Iatrogenic aortic dissection (AD) is a rare but severe complication associated with coronary angiography and interventions. The primary cause of AD is the retrograde extension of coronary artery dissection. Guiding catheter-induced aortocoronary dissection can rapidly deteriorate a patient's hemodynamic status, particularly if the coronary artery was previously patent or if the AD extends >40 mm. In this report, we present a case involving a right coronary artery with chronic total occlusion that was dissected to the crux during guiding catheter engagement, with dissection retrogradely extending to the aorta. We successfully treated the chronic total occlusion lesion using a retrograde approach and addressed the intramural hematoma with a cutting balloon (Wolverine). The retrograde AD was managed conservatively with intensive care unit follow-up. The patient was discharged in good health. Prompt diagnosis and management of aortocoronary dissection are crucial to prevent adverse outcomes and improve survival rates.