Conservative Management of Iatrogenic Type a Aortic Dissection Occurring During Percutaneous Coronary Intervention

Iatrogenic type A aortic dissection (TAAD) during percutaneous coronary intervention (PCI) is a rare but life-threatening complication, usually managed surgically.

We report the case of a 59-year-old patient who developed an ascending aortic dissection extending to the proximal arch during left circumflex (LCX) chronic total occlusion (CTO) recanalization. Stenting of the LCX and left main coronary artery successfully sealed the entry site and stabilized the patient. Computed tomography revealed a false lumen occupying 51% of the aortic diameter, without involvement of supra-aortic branches. Conservative management was initiated with strict anti-impulse therapy and staged dual antiplatelet therapy. At 24 h, the false lumen regressed to 37%, with complete resolution by Day 7.

In selected cases of iatrogenic TAAD during PCI, conservative management following successful sealing of the entry tear may represent a safe alternative to sugery.