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[Interventional coronary revascularization in a patient with chronic dissection of the ascending aorta]
Y von Kodolitsch1, C A Nienaber, T Meinertz
1Universitätskrankenhaus Eppenderf, Abteilung für Kardiologie, Hamburg.
Insights
This study reports a complex percutaneous coronary intervention in a patient with chronic type A aortic dissection and severe coronary artery disease. The successful procedure highlights interventional cardiology
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- A 74-year-old patient with a history of coronary artery bypass grafting presented with angina pectoris.
- Pre-existing coronary artery disease and a prior coronary artery bypass graft (CABG) surgery.
- The patient had undergone CABG 8 years prior to the current presentation.
Observation:
- Angiography revealed chronic type A aortic dissection.
- Occlusion of a saphenous vein graft and partial thrombosis of the false lumen were noted.
- Significant progression of coronary artery disease, including new stenoses in the saphenous vein graft and left main coronary artery stenosis.
Findings:
- The patient refused surgical intervention.
- A complex interventional therapeutic strategy involving percutaneous transluminal dilatation and stenting was planned and successfully performed.
- This represents the first reported complex intervention and revascularization in a patient with type A aortic dissection.
Implications:
- Selected cases of chronic type A aortic dissection may be suitable for interventional coronary revascularization.
- Percutaneous coronary intervention can be a viable option for acute coronary syndromes in patients with chronic aortic dissection.
- This case expands treatment options for patients with complex cardiovascular conditions involving aortic dissection and coronary artery disease.
Abstract:
In a 74-year-old patient who had undergone coronary artery bypass grafting 8 years earlier, angiography was performed for recent onset of angina pectoris. Surprisingly, angiography revealed chronic dissection of the ascending aortic vessel with occlusion of a saphenous vein graft and partial thrombosis of the false lumen. Additionally, there was significant progression of coronary artery disease with new stenoses in both the ostium and body of the saphenous vein graft to the right coronary artery and a high grade left main coronary artery stenosis. Because any surgical intervention was refused by the patient, an interventional therapeutic strategy with percutaneous transluminal dilatation and stenting of both the bypass graft and the left main coronary artery was planned and successfully performed. This is the first report of a complex intervention and revascularization procedure carried out in a patient with type A aortic dissection. Thus, selected cases of chronic type A dissection my be amenable to interventional coronary revascularization in acute coronary syndromes.