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

Mohamed El Mallouli1, Chirine Liu1, Romain Van Der Linden1

  • 1Department of Cardiology, CHU Brugmann, Brussels, Belgium.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 13, 2026
PubMed

Insights

Iatrogenic type A aortic dissection (TAAD) during percutaneous coronary intervention (PCI) can be managed conservatively. Successful sealing of the entry tear allowed for non-surgical treatment with positive outcomes.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Iatrogenic type A aortic dissection (TAAD) is a rare, life-threatening complication of percutaneous coronary intervention (PCI).
  • Surgical management is the traditional approach for TAAD.
  • This case highlights a potential alternative management strategy.

Purpose of the Study:

  • To report a case of iatrogenic TAAD during PCI.
  • To evaluate the feasibility of conservative management in selected TAAD cases.
  • To demonstrate the efficacy of non-surgical treatment following successful sealing of the entry tear.

Main Methods:

  • A 59-year-old patient developed ascending aortic dissection during left circumflex (LCX) chronic total occlusion (CTO) recanalization.
  • Successful sealing of the entry tear was achieved with stenting of the LCX and left main coronary artery.
  • Conservative management included anti-impulse therapy and dual antiplatelet therapy.

Main Results:

  • Computed tomography showed a false lumen occupying 51% of the aortic diameter, without supra-aortic branch involvement.
  • The false lumen regressed to 37% within 24 hours.
  • Complete resolution of the false lumen was observed by Day 7.

Conclusions:

  • Conservative management can be a safe alternative to surgery in selected iatrogenic TAAD cases.
  • Successful sealing of the entry tear is crucial for conservative treatment success.
  • This approach may avoid surgical risks in specific patient populations.
Abstract

Keywords:
Iatrogenic aortic dissectioncomplication PCIconservative management

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