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Jacob A, Hara N, Goli G, Lall K. Right coronary artery dissection after aortic valve replacement presenting with refractory ventricular fibrillation. J Surg Case Rep 2024; 2024:rjad717. [PMID: 38239373 PMCID: PMC10795924 DOI: 10.1093/jscr/rjad717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Iatrogenic coronary artery dissection is a rare complication seen in 0.07% of coronary procedures. Presentations of this condition vary, ranging from signs of myocardial ischemia to rarer presentations of ventricular arrhythmias. We present a rare case of a 55-year-old patient with native aortic valve endocarditis who developed right coronary artery dissection (RCAD) in the immediate post-op period presenting with refractory ventricular fibrillation (VF). Emergency coronary angiogram revealed an extensive RCAD extending from the ostium to the mid-vessel as the cause of VF. A consensus between the cardiologists and the cardiac surgeons led to an emergency right coronary artery bypass graft (CABG) that resolved the VF. This case illustrates a rare presentation of iatrogenic RCAD and the successful management of the same. We highlight the importance of prompt detection via angiography in patients suspected of having coronary artery dissection and showcase the successful implementation of emergency CABG in a patient with unstable haemodynamics.
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Affiliation(s)
- Abiah Jacob
- Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
| | - Natalia Hara
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 2AD London, United Kingdom
| | - Giridhara Goli
- Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
| | - Kulvinder Lall
- Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
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2
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Sanchez-Jimenez E, Levi Y, Roguin A. Iatrogenic Aortocoronary Dissection During Right Coronary Artery Procedures: A Systematic Review of the Published Literature. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100443. [PMID: 39132357 PMCID: PMC11308116 DOI: 10.1016/j.jscai.2022.100443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 08/13/2024]
Abstract
Iatrogenic aortocoronary dissection (IACD) occurs mainly during procedures involving the right coronary artery (RCA) and can result in disabilities, the need for urgent complex surgery, and even death. The risk factors for IACD are ill characterized, and the best management strategy is questionable; thus, there is a need to evaluate the characteristics, treatment options, and outcomes of patients with IACD of the RCA. We searched medical databases for publications on IACD of the RCA to present the characteristics of the procedures, management, and outcomes. We report 142 cases of IACD of the RCA, reported between 1973 and 2021. The mean age of the patients was 63.0 years, 81 (57%) were men, 75 (52.8%) presented with stable angina, and 29 (20.4%) had chronic total occlusion of the RCA. The most used catheter shapes were Judkins right (42%) and Amplatz left (25%), and most (56%) catheters were used during percutaneous coronary interventions. Guiding catheters were used in 38% (19/50) of diagnostic procedures when IACD occurred. A catheter size of ≤5F was used in only 3 cases. The catheter size was 6F in 22% of the cases, >6F in 23%, and not reported in 52%. A high-grade dissection (Dunning class III) occurred in 54% (77/142) of the cases. Stenting of the RCA ostium was performed in 88 (62%) of the cases, conservative treatment in 25 (18%), and surgery in 40 (28%) (aortic root repair [5%], coronary artery bypass grafting and aortic root repair [11%], and coronary artery bypass grafting alone [10%]). The mortality rate was 6.5% (5/77) among patients with class III dissection. Each patient should be considered independently. The most frequent intervention was to seal the dissection with a stent in the ostial RCA. However, in select cases published in the literature, a conservative approach was a feasible and successful option.
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Affiliation(s)
| | - Yaniv Levi
- Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Technion - Israel Institute of Technology, Israel
| | - Ariel Roguin
- Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Technion - Israel Institute of Technology, Israel
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3
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Tokumasu Y, Obata JE, Oka S, Hoshina K, Watanabe K, Nakamura J, Abe M, Watanabe A. Healing of iatrogenic double-barrel left main coronary artery dissection extending to the left anterior descending artery. J Cardiol Cases 2021; 24:64-67. [PMID: 34354780 DOI: 10.1016/j.jccase.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022] Open
Abstract
Iatrogenic left main coronary artery (LMCA) dissection is a complication inadvertently caused by the interventional cardiologist and can have significant consequences. A 38-year-old man presented to hospital with non-ST-elevation myocardial infarction. Coronary angiography (CAG) revealed an obstructed proximal left circumflex artery (LCx) that was successfully treated with revascularization using a drug-eluting stent (DES). However, CAG after recanalization of the LCx demonstrated a spiral dissection of the left coronary artery from the mid-LMCA to the left anterior descending (LAD) artery and LCx. The dissection was classified as National Heart, Lung and Blood Institute type D in LAD and type F in LCx. Immediate exclusion stenting of the dissection flap by another DES and thrombolysis in myocardial infarction 3 flow were achieved in the LAD and LCx. The patient achieved hemodynamic stability with improvement in symptoms, despite residual dissection in the LAD. We, therefore, preferred careful observation over revascularization. The false lumen remained visible with a double-barrel appearance in the LAD on 6-month follow-up CAG, which disappeared at the 2-year follow-up. We report a rare case of a large double-barrel dissection that spontaneously occluded over time without any aggressive interventions. <Learning objective: Iatrogenic left main coronary artery (LMCA) dissection is a rare but potentially life-threatening complication, with the associated risk of serious outcomes. Immediately after suffering a LMCA dissection, treatment strategies (conservative therapy, percutaneous coronary intervention, or coronary bypass grafting etc.) should be determined according to patient's symptoms and hemodynamic status. However, treatment strategies for chronic LMCA dissection are uncertain. Our case indicates that conservative therapy appears to be a potential option for the treatment of chronic asymptomatic and hemodynamically stable LMCA dissection.>.
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Affiliation(s)
- Yoshinori Tokumasu
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
| | - Jyun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Satoshi Oka
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
| | - Katsuomi Hoshina
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
| | - Kazunori Watanabe
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
| | - Jun Nakamura
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
| | - Makoto Abe
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
| | - Akinori Watanabe
- Department of Cardiology Internal Medicine, Fujieda Municipal General Hospital, Fujieda City, Shizuoka, Japan
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4
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Management of iatrogenic left main coronary artery dissection in a center without onsite cardiac surgery back up. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.707225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Huo D, Kou B, Zhou Z, Lv M. A machine learning model to classify aortic dissection patients in the early diagnosis phase. Sci Rep 2019; 9:2701. [PMID: 30804372 PMCID: PMC6389887 DOI: 10.1038/s41598-019-39066-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 10/06/2018] [Indexed: 12/03/2022] Open
Abstract
Aortic dissection is one of the most clinical-challenging and life-threatening cardiovascular diseases associated with high morbidity and mortality. Aortic dissection requires fast diagnosis and timely therapy. Any delay or misdiagnosis can cause severe consequence to aortic dissection patients with even higher mortality. To better help physicians identify the potential dissection within the scope of all misdiagnosed patients, this paper describes a method which is developed with data mining methods for aortic dissection patient classification and prediction in the phase of early diagnosis. Various machine learning algorithms were used to build the models which were all trained and tested on the patient dataset with cross validation. Among them, Bayesian Network model achieved the best performance by predicting at a precision rate of 84.55% with Area Under the Curve (AUC) value of 0.857. On this basis, the Bayesian Network model can help physicians better with early diagnosis of aortic dissection in clinical practice. Beyond this study, more data from diverse regions and the internal pathology can be crucial to further build a universal model with broader predictive power.
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Affiliation(s)
- Da Huo
- School of Management, Xi'an Jiaotong University, Xi'an, 710049, China
- Department of System Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong SAR
| | - Bo Kou
- School of Management, Xi'an Jiaotong University, Xi'an, 710049, China.
- Department of Otorhinolaryngology-Head & Neck Surgery, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Zhili Zhou
- School of Management, Xi'an Jiaotong University, Xi'an, 710049, China
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ming Lv
- School of Management, Xi'an Jiaotong University, Xi'an, 710049, China
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Attar MN, Bury R, Galasko G. Iatrogenic Aortocoronary Dissection Successfully Treated by Coronary Intervention. Heart Int 2018. [DOI: 10.4081/hi.2011.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- M. Nadeem Attar
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Roger Bury
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Gavin Galasko
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
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Valappil SP, Iype M, Viswanathan S, Koshy AG, Gupta PN, Velayudhan RV. Coronary angioplasty in spontaneous coronary artery dissection-Strategy and outcomes. Indian Heart J 2018; 70:843-847. [PMID: 30580854 PMCID: PMC6306396 DOI: 10.1016/j.ihj.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/23/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study the clinical, angiographic and technical characteristics of patients with spontaneous coronary artery dissection (SCAD) undergoing percutaneous coronary intervention (PCI). METHODS This was a retrospective single center study where patients with angiographically confirmed SCAD undergoing PCI over a period of 4 years (2013-2017) were analyzed. We also sought to identify the clinical and angiographic predictors of procedural failure during PCI. RESULTS There were a total of 42 patients with angiographically confirmed SCAD during the study period of which 16 patients (38.1%) underwent PCI. 14 out of the 16 patients (87.5%) taken up for PCI had technical success. In all patients the lesion was initially attempted to cross with a floppy wire and if unsuccessful it was escalated to a hydrophilic wire and finally to a stiff wire The SCAD lesion was crossed with a floppy wire in 71.4% of patients, with a hydrophilic wire in 14.2% and a stiff wire in 7.1% of patients. Wire escalation was required in 5 patients (31.3%) and in 60% of cases there was a technical success after wire escalation. Presence of diabetes mellitus, hypertension, dyslipidemia, smoking, coexisting atherosclerosis, diffuse nature of the lesion, and baseline Thrombolysis in Myocardial Infarction (TIMI)≤2 flow did not predict procedural failure during PCI. CONCLUSION PCI in SCAD is associated with a fair rate of technical success in our population. Choosing an initial floppy wire and then escalating to a hydrophilic wire followed by a stiff wire is an optimal revascularization strategy.
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Affiliation(s)
- Sanjai Pattu Valappil
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala, 695011, India.
| | - Mathew Iype
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala, 695011, India
| | - Sunitha Viswanathan
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala, 695011, India
| | | | - Prabha Nini Gupta
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala, 695011, India
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8
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Nasrin S, Cader FA, Haq MM, Karim MR. Right coronary artery perforation extending to the coronary sinus of Valsalva during percutaneous intervention successfully sealed with polytetrafluoroethylene-covered stent: a case report. BMC Res Notes 2017; 10:537. [PMID: 29084606 PMCID: PMC5663076 DOI: 10.1186/s13104-017-2867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022] Open
Abstract
Background Right coronary artery perforation extending to the sinus of Valsalva is a rare and potentially fatal complication of percutaneous coronary intervention. There are no definite guidelines on the management strategies for such complications. Treatment modality depends on the patient’s haemodynamic stability and the extent of aortic involvement. Polytetrafluoroethylene-covered stents have emerged as a revolutionary strategy, enabling efficient endovascular repair of the entry port of such dissections, particularly the coronary ostia, and obviating the need for high-risk emergent surgical intervention. Case presentation A 60 year old Bangladeshi gentleman underwent a coronary angiogram following a prior inferior ST elevation myocardial infarction (MI), 1 month previously. Coronary angiography done via right radial approach using 5 FR TIG catheter showed diffuse mid RCA disease with maximum 90% stenosis. Angioplasty of the RCA was planned. The RCA was cannulated with a 6-French JR 3.5 guiding catheter (USA). The lesion was crossed by a 0.014 inch guide wire and stented with a 2.75 × 38 mm novolimus-eluting DESyne stent, after predilatation. Immediately after stenting, a Type II perforation was observed in the ostial RCA, which progressed into the right coronary sinus of Valsalva. As the patient was haemodynamically stable with no ischaemia on ECG, we attempted to seal the ostial RCA with bare metal stents. Two successive bare metal stents failed to seal the aorto-coronary dissection. Ultimately, a 3.0 × 19 mm polytetrafluoroethylene-covered stent was deployed to seal the entry port in the ostial RCA, yielding a satisfactory angiographic result with only minimal contrast staining limited to the right sinus of Valsalva. The patient was closely monitored and discharged on dual antiplatelet therapy comprising of aspirin and prasugrel. He remained asymptomatic and with follow up echocardiograms showing no pericardial effusion nor extension of the dissection. Conclusions The polytetrafluoroethylene-covered stent provides a safe and effective means of sealing iatrogenic aorto-coronary dissections complicated by Ellis type II or II perforations, thus avoiding emergency surgery. However, as they are associated with increased incidence of stent thrombosis, an efficient and prolonged post-PCI antiplatelet regimen is recommended. Electronic supplementary material The online version of this article (10.1186/s13104-017-2867-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahela Nasrin
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh
| | - Fathima Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh. .,National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
| | - M Maksumul Haq
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh
| | - Md Rezaul Karim
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh
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9
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Patel TM, Shah SC, Ranjan A. Unusual Retrograde Aortic Arch Dissection During Percutaneous Coronary Intervention. Angiology 2016; 57:501-5. [PMID: 17022387 DOI: 10.1177/0003319706290626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coronary dissection is one of the most frequently occurring complications during coronary interventional procedures. However, extensive coronary dissection retrograde to the coronary sinus of Valsalva and to the arch of aorta is very rarely observed. The authors report a case of retrograde coronary dissection extending into the arch of aorta. Management and coronary angiography at 6-month follow-up are discussed.
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Affiliation(s)
- Tejas M Patel
- Department of Cardiology, Krishna Heart Institute, Ahmedabad, India
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10
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Isolated aortic dissection during coronary intervention: rare but challenging. Cardiovasc Interv Ther 2015; 31:300-3. [PMID: 26395003 DOI: 10.1007/s12928-015-0358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
Abstract
Catheter-induced aortic dissection without involvement of the coronary arteries is an extremely rare complication of percutaneous coronary intervention. Management strategies vary depending on clinical scenarios, however, the choice of strategy prompt recognition and early aggressive management is key to patient outcomes.
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11
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de Barros e Silva PGM, Aquino T, Resende MV, Richter I, Barros CM, Andrioli VG, Baruzzi AC, Medeiros CCJ, Furlan V. Resolution of an acute aortic syndrome with aortic valve insufficiency post-PCI. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:508-13. [PMID: 25413612 PMCID: PMC4243591 DOI: 10.12659/ajcr.891301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute aortic syndrome is the modern term that includes aortic dissection, intramural hematoma, and symptomatic aortic ulcer. Iatrogenic coronary artery dissection extending to the aorta during percutaneous coronary intervention is a very rare but life-threatening complication. Despite some reports of spontaneous recovery, most of these patients are treated surgically as a spontaneous aortic dissection, especially if there is a complication of the aortic lesion. CASE REPORT A 52-year-old white female was submitted to an angioplasty in the right coronary without success and the procedure was complicated by a dissection in aortic root with progressive extension to the ascending aorta. This lesion deformed the aortic valve, leaving it with an acute moderate regurgitation. Because of current use of clopidogrel and clinical stability of the patient, the local Heart Team decided to withdrawn this antiplatelet for 5 days before surgery despite the risk related to the aortic syndrome. A new echocardiogram 3 days later showed that the hematoma was reabsorbed with improvement of the aortic insufficiency. An angiotomography confirmed the reabsorption of the hematoma. The surgery was canceled and the patient was maintained in a conservative treatment and discharged. Seventeen months later, she was re-evaluated and was still asymptomatic without aortic regurgitation in the echocardiogram and showing progressive regression of the aortic hematoma in the tomography. CONCLUSIONS Despite the conservative treatment, this case of iatrogenic aortic dissection complicated by an acute aortic regurgitation had a good evolution in a follow-up of 17 months.
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Affiliation(s)
| | - Thiago Aquino
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
| | - Marcos V Resende
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
| | - Ivo Richter
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
| | - Cecilia M Barros
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
| | | | - Antonio C Baruzzi
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
| | - Caio C J Medeiros
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
| | - Valter Furlan
- Department of Clinical Research, Hospital Totalcor, Sao Paulo, Brazil
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12
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Barbero C, Di Rosa E, Devotini R, Attisani M, Rinaldi M. Left main coronary artery ostial repair with autologous ring-shaped aortic patch for iatrogenic aortic dissection. J Card Surg 2014; 29:821-3. [PMID: 25269622 DOI: 10.1111/jocs.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Iatrogenic left main coronary artery and aortic root dissection are rare complications during coronary catheterization. A case of catheter-induced left main coronary artery dissection with subsequent retrograde progression into the ascending aorta wall is reported. The patient was surgically managed with an ascending aorta replacement and left coronary ostial repair with an autologuos aortic wall ring-shaped patch in the paraostial position in order to seal the intimal tear.
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Affiliation(s)
- Cristina Barbero
- PhD Programme in Applied Technologies to Surgical Science, Division of Cardiac Surgery, Città della Salute e della Scienza Hospital, "Molinette", University of Torino, Torino, Italy; Division of Cardiac Surgery, Città della Salute e della Scienza Hospital, "Molinette", University of Torino, Torino, Italy
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13
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Binder RK, Boone RH, Webb JG. Left main dissection conservatively managed with optical coherence tomography guidance. Catheter Cardiovasc Interv 2014; 83:65-8. [PMID: 23613429 DOI: 10.1002/ccd.24978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/14/2013] [Indexed: 11/12/2022]
Abstract
Left main dissection (LMD) is a rare but feared complication of cardiac catheterization. It is usually managed by bailout stent implantation or coronary artery bypass surgery. We describe a case of iatrogenic, retrograde LMD during percutaneous coronary intervention. After covering the retrograde entry of the dissection in the ostial left anterior descending artery (LAD), optical coherence tomography (OCT) showed, that there was no antegrade entry in the left main and that the minimal true lumen area in the left main was 7.2 mm(2) . It was therefore decided to treat the LMD conservatively and reassess the results by angiography 6 months later. At follow-up angiography, no stenosis or residual dissection in the left main were noted. The patient was doing fine at 1-year follow-up. OCT is a valuable tool for assessing coronary artery dissections and may guide the decision, whether to stent or not to stent a dissection. In selected cases LMD may be managed conservatively.
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Affiliation(s)
- Ronald K Binder
- St. Paul's Hospital, University of British Columbia, V6Z 1Y6, Vancouver, BC, Canada
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14
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Hung MY, Hung MJ, Degertekin M, Ozveren O, Eroglu E, Fournial G. How should I treat a retrograde dissection of the aortic sinus of Valsalva during a percutaneous coronary intervention? EUROINTERVENTION 2012; 8:520-7. [PMID: 22917734 DOI: 10.4244/eijv8i4a80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ming-Yow Hung
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
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15
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Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V, Escaned J, Bañuelos C, Hernandez R, Macaya C. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol 2012; 59:1073-9. [PMID: 22421300 DOI: 10.1016/j.jacc.2011.08.082] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 08/03/2011] [Accepted: 08/26/2011] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study sought to assess the diagnostic value of optical coherence tomography (OCT) in patients with suspected spontaneous coronary artery dissection (SCAD). BACKGROUND SCAD is a rare but challenging clinical entity. METHODS Following a prospective protocol, OCT was performed in 17 consecutive patients with a clinical and angiographic suspicion of SCD from a total of 5,002 patients undergoing coronary angiography. A conservative management strategy was followed. RESULTS OCT ruled out the diagnosis of SCAD in 6 patients with coronary artery disease (atherosclerotic plaques and/or intracoronary thrombus). In 11 patients (age 48 ± 9 years, 9 female), OCT confirmed the presence of SCAD. A double-lumen or intramural hematoma image was visualized in all cases. However, only 3 patients presented an intimal "flap" on angiography. OCT readily identified the intimal rupture site (n = 7), the thickness (348 ± 84 μm) and length (31 ± 9 mm) of the intimomedial membrane, the area of the true (1.1 ± 0.5 mm(2)) and false lumen (5.9 ± 2.1 mm(2)), the associated intramural hematoma (n = 9), and thrombi in the true or false lumens (n = 11). Most of these findings were angiographically silent. After stenting (n = 4), OCT disclosed adequate stent coverage, expansion, and apposition, but also residual intramural hematoma at the stented site (abluminal) and at the distal vessel. CONCLUSIONS OCT provides unique insights in patients with SCAD that allow an early diagnosis and adequate management. Most of these findings are undetectable by angiography.
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Affiliation(s)
- Fernando Alfonso
- Interventional Cardiology Unit, Cardiovascular Institute, IdISSC, Complutense University, Clínico San Carlos, University Hospital, Madrid, Spain.
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16
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Wykrzykowska JJ, Ligthart J, Lopez NG, Schultz C, Garcia-Garcia H, Serruys PW. How should I treat an iatrogenic aortic dissection as a complication of complex PCI? EUROINTERVENTION 2012; 7:1111-7. [DOI: 10.4244/eijv7i9a176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Mouillet G, Deux JF, Lesault PF, Gellen B, Dubois-Rande JL, Teiger E, Champagne S. How should I treat a huge intra-mural haematoma of the ascending aorta after coronary angioplasty? EUROINTERVENTION 2011; 7:278-84. [PMID: 21646073 DOI: 10.4244/eijv7i2a45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gauthier Mouillet
- Department of physiology, Henri Mondor University Hospital, Val-de-Marne University, Créteil, France.
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18
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Tendulkar A, Haque R, Bernstein W, Griffith B, Bonatti J. Dissection of the left main coronary artery during percutaneous intervention: successful surgical management. Heart Surg Forum 2010; 13:E402-4. [PMID: 21169154 DOI: 10.1532/hsf98.20101153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coronary dissection during diagnostic catheterization presents a therapeutic challenge. Medical management or percutaneous intervention may be an option in a stable patient. Unstable patients should promptly undergo surgical revascularization. We report on a patient in whom dissection of the left main coronary artery, the left anterior descending artery, and a diagonal branch occurred during catheterization. Clear signs of myocardial ischemia indicated immediate surgery. Coronary artery bypass grafting was carried out within a very short time frame and the patient survived. This case demonstrates the value of an expeditious surgical treatment strategy.
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Affiliation(s)
- Amod Tendulkar
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD, USA.
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19
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Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seiler C, Meier B, Windecker S, Carrel T, Wenaweser P, Cook S. Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up. Am Heart J 2010; 159:1147-53. [PMID: 20569732 DOI: 10.1016/j.ahj.2010.03.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 03/10/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although rare, iatrogenic left main coronary artery (LM) dissection is a feared complication of coronary catheterization. Its incidence, optimal therapeutic management, and prognosis remain largely unknown. The aim of the present study was to estimate the incidence, characterize the population at risk, depict the initial management, and evaluate the long-term prognosis of iatrogenic LM dissection. METHODS Thirty-eight patients who fulfilled the National Heart, Lung, and Blood Institute diagnostic criteria for iatrogenic LM dissection were retrieved from our database and followed up by telephone or physician visit. The primary end point was freedom from major adverse cardiac events (MACE) at 5 years. RESULTS The overall incidence of iatrogenic LM dissection during the study period was 0.07% (38/51,452 patients) and almost twice as common with percutaneous coronary intervention than coronary angiography. From 38 patients, 1 (3%) patient died before any therapeutic attempt was performed, 6 (16%) patients were treated conservatively, and 31 (82%) patients underwent stent implantation and/or coronary artery bypass grafting (CABG). In-hospital outcome was favorable irrespective of the therapeutic strategy. During the 5-year follow-up, among 31 patients who underwent revascularization treatment by stenting or CABG, one patient died in each group from a cardiac cause, and MACE were observed in 12 patients (39%). Kaplan-Meier cumulative survival estimates showed no significant difference between different revascularization treatment strategies. CONCLUSIONS Iatrogenic LM dissection is a rare complication of cardiac catheterization procedures with favorable early and long-term outcome when recognized timely and managed properly.
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Affiliation(s)
- Parham Eshtehardi
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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20
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Closure of the left main trunk of the coronary artery and total arch replacement in acute type A dissection during coronary angiography. Ann Thorac Surg 2010; 89:618-21. [PMID: 20103360 DOI: 10.1016/j.athoracsur.2009.06.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 06/11/2009] [Accepted: 06/30/2009] [Indexed: 11/20/2022]
Abstract
A 64-year-old woman was complicated with acute type A dissection arising from the left main trunk during percutaneous coronary angiography. As the extent of dissection was localized in the ascending aorta, a bare-metal stent was inserted into the left main trunk to cover the entry of dissection. Two days after an angiography, the patient's hemodynamic status suddenly deteriorated. A computed tomographic scan showed expansion of a thrombosed false lumen severely compressing the true lumen. Emergency total arch replacement was performed, combined with ligation of the left main trunk and coronary artery bypass grafting. The patient recovered well without residual dissection in the sinus of Valsalva.
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21
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Abstract
Aortic dissection is an uncommon but potentially fatal disease with catastrophic complications. A high level of suspicion is required for successful diagnosis as presenting symptoms are so variable that dissection may be overlooked in up to 39% of cases. It most commonly presents in the elderly population with a history of chronic hypertension. Rapid intervention is necessary as delay leads to higher mortality. Despite advances in diagnostic and therapeutic techniques, morbidity and mortality remains high. Advances in diagnostic imaging have raised the awareness of variants of aortic dissection, including intramural hemorrhage and penetrating aortic ulcer. This distinction is important as the clinical course of these variants differs from that of classical aortic dissection, and thus treatment may also differ. Understanding of these variants has also led to the recognition of markers that may help predict progression to classical aortic dissection and thus warrant closer vigilance in selected patient populations. The recognition that rapid diagnosis is required for management of aortic dissection has led to the investigation of serum tests as diagnostic aids. Serum smooth muscle myosin heavy chain, d-dimer, and serum soluble elastin fragments are promising tests that may help raise suspicion for the diagnosis of acute aortic dissection. The high mortality associated with surgical therapy has led to investigation of alternative approaches. Endovascular therapy has emerged as a viable option in patients with type B dissection who are too unstable for surgery. However, long-term follow up is required to validate this procedure.
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Affiliation(s)
- Pawan D. Patel
- Department of Cardiology, Chicago Medical School, North Chicago VA Medical Centre-133B, 3001 Green Bay Road, North Chicago, IL-60064
| | - Rohit R. Arora
- Department of Cardiology, Chicago Medical School, North Chicago VA Medical Centre-133B, 3001 Green Bay Road, North Chicago, IL-60064,
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22
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Carstensen S, Ward MR. Iatrogenic Aortocoronary Dissection: The Case for Immediate Aortoostial Stenting. Heart Lung Circ 2008; 17:325-9. [PMID: 18294905 DOI: 10.1016/j.hlc.2007.11.140] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 11/14/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
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23
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Gasparini GL, Parenti DZ, Rossi ML, Pagnotta P, Belli G, Presbitero P. Percutaneous treatment of severe retrograde dissection of the circumflex artery involving left main stem and extending into the sinus of Valsalva. Int J Cardiol 2007; 130:494-6. [PMID: 17706804 DOI: 10.1016/j.ijcard.2007.05.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 05/11/2007] [Indexed: 11/26/2022]
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24
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Ciabatti N, De Carlo M, Gistri R, Branchitta G, Petronio AS. Aorto-coronary dissection during angioplasty in a patient with history of radiation therapy for breast cancer. Int J Cardiol 2007; 117:e33-4. [PMID: 17296238 DOI: 10.1016/j.ijcard.2006.11.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 11/12/2006] [Indexed: 10/23/2022]
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25
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López-Mínguez JR, Climent V, Yen-Ho S, González-Fernández R, Nogales-Asensio JM, Sánchez-Quintana D. Características estructurales de los senos de Valsalva y porción proximal de las arterias coronarias. Su relevancia durante la disección retrógrada aortocoronaria. Rev Esp Cardiol 2006. [DOI: 10.1157/13091371] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Pohlel K, Lerakis S, Arita T, Rab T, Martin RP. Intracoronary stent visualized on transesophageal echocardiogram in a case of coronary dissection complicated by aortic dissection. J Am Soc Echocardiogr 2006; 19:229.e1-229.e3. [PMID: 16455430 DOI: 10.1016/j.echo.2005.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2005] [Indexed: 10/25/2022]
Abstract
We present a case of a patient presenting with a myocardial infarction with subsequent coronary intervention resulting in a coronary dissection complicated by an aortic dissection. The coronary dissection was treated with coronary stents. Transesophageal echocardiogram visualized the intracoronary stent within the intimal flap of the aortic dissection. The aortic dissection was successfully managed conservatively.
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Affiliation(s)
- Khan Pohlel
- Emory University School of Medicine, Atlanta, GA 30322, USA
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27
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Lee G, Yan BPY, Ahmar W, Shetty S, Ajani AE. Anomalous right coronary artery angioplasty complicated by intramural hematoma in the ascending aorta. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2005; 6:170-3. [PMID: 16326379 DOI: 10.1016/j.carrev.2005.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 11/23/2022]
Abstract
An iatrogenic intramural hematoma (IMH) localized in the ascending aorta is a rare and potentially life-threatening complication following percutaneous coronary intervention (PCI). We describe the case of an ascending aortic IMH after the PCI of an anomalous right coronary artery. Early extension of the hematoma was observed during transesophageal echocardiography; the patient underwent successful surgical repair.
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Affiliation(s)
- Geoff Lee
- Royal Melbourne Hospital, Victoria, Australia
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28
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Notaristefano S, Giombolini C, Santucci S, Fortunati F, Savino K, Notaristefano A, Ambrosio G. Successful treatment by percutaneous stent deployment of severe retrograde dissection of the right coronary artery extending into the sinus of Valsalva and ascending aorta. Int J Cardiol 2005; 104:112-4. [PMID: 16137523 DOI: 10.1016/j.ijcard.2004.10.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2004] [Accepted: 10/16/2004] [Indexed: 11/22/2022]
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29
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Kim JY, Yoon J, Jung HS, Yoo BS, Lee SH. Percutaneous coronary stenting in guide-induced aortocoronary dissection: angiographic and CT findings. Int J Cardiovasc Imaging 2005; 21:375-8. [PMID: 16047116 DOI: 10.1007/s10554-004-6137-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 11/04/2004] [Indexed: 11/30/2022]
Abstract
We report here on a case of accidental aortocoronary dissection that occurred during the engagement of a guiding catheter. This resulted in an antegrade dissection into the right coronary artery, and a retrograde extension of the dissection into the Sinus of Valsalva and the ascending aorta up to the aortic arch. It was successfully treated with a stent deployment at the RCA ostium; this restored optimal coronary blood flow and there was a complete resolution of the aortic dissection as was documented by coronary angiography and the follow-up CT scan.
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Affiliation(s)
- Jang-Young Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, 162 Ilsan-Dong, 220 701, Wonju, Republic of Korea
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30
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Pascotto M, Severino S, Caso P, Covino F, Rossi G, Mininni N, Calabrò R. Conservative therapeutic approach in a case of coronary dissection extending into the aortic root complicating coronary angioplasty. J Am Soc Echocardiogr 2005; 18:481-2. [PMID: 15891759 DOI: 10.1016/j.echo.2004.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marco Pascotto
- Division of Cardiology, Second University of Naples, Italy.
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31
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Chai HT, Yang CH, Wu CJ, Hang CL, Hsieh YK, Fang CY, Chen SM, Yu TH, Hung WC, Chen YH, Cheng CI, Yip HK. Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms. Int Heart J 2005; 46:35-44. [PMID: 15858935 DOI: 10.1536/ihj.46.35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While coronary artery dissection caused by a guiding catheter, which is one of the most commonly occurring complications during diagnostic cardiac catheterization or coronary intervention, has various forms, extensive antegrade and retrograde dissections of the right coronary artery (RCA) are rarely observed during these procedures. Within the last three years, we retrospectively reviewed our experience with 12,600 consecutive patients who underwent either diagnostic cardiac catheterization or coronary angioplasty, and found that 17 (0.14%) of the patients displayed extensive antegrade and retrograde RCA dissection. The antegrade dissection always propagated to the distal RCA either on bifurcation of the posterior descending artery and posterolateral artery (PLA) or to the proximal PLA. The retrograde dissection was always observed close to the ostium of the RCA or extending to the ostium of the RCA. TIMI-0 flow in the RCA was immediately observed in all the patients. Chest pain associated with an electrocardiogram showing ST-segment elevation was soon observed in most of the patients. The true lumen could be entered successfully using a single wire in 8 of 17 patients. However, a double-wire technique was required for 7 patients. This technique involved first advancing a wire along to the false lumen and then pulling back the guiding catheter away from the ostium of the RCA for a few millimeters followed by anchoring with the wire. Another wire was then gently inserted into the true lumen from the dissection entrance point, which was located near or at the ostium of RCA, and carefully advanced to the distal RCA. Coronary stenting was successfully deployed in 15 patients. However, the procedure failed in 2 patients. Furthermore, this complication caused 7 patients to have acute myocardial infarctions, 2 patients to develop atrial fibrillation, and I to die from ischemic enterocolitis due to cardiac embolism after 7 months of follow-up. In conclusion, with an increase in experience, we now better understand this complication. However, this complication, which is a formidable challenge for coronary intervention, may be a life-threatening complication, and patients with this complication may face the potential risk of a nonfatal myocardial infarction, or even a long-term fatal outcome in the long-term. Accordingly, it is important to learn how to promptly manage this complication.
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Affiliation(s)
- Han-Tan Chai
- Chang Gung Memorial Hospital, Kaohsiung Kaohsiung, Taiwan, ROC
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32
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Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation 2003; 108:628-35. [PMID: 12900496 DOI: 10.1161/01.cir.0000087009.16755.e4] [Citation(s) in RCA: 368] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Christoph A Nienaber
- Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany.
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33
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Bloch MJ, Trost DW, Sos TA. Type B aortic dissection complicating renal artery angioplasty and stent placement. J Vasc Interv Radiol 2001; 12:517-20. [PMID: 11287541 DOI: 10.1016/s1051-0443(07)61893-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Percutaneous renal artery stent placement has been demonstrated to improve blood pressure control and stabilize renal function in patients with atherosclerotic renal artery disease. However, this procedure is not without risk of significant morbidity, and its effectiveness, as compared to alternative treatments, has not been adequately established. The authors report a case of acute type B aortic dissection complicating renal artery stent placement. The authors postulate that an intimal disruption occurred during initial balloon angioplasty, and that repeated application of radial, shear, and torque forces during stent placement may have extended the injury. The diagnosis of acute aortic dissection should be considered in patients with suggestive symptoms immediately after stent placement.
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Affiliation(s)
- M J Bloch
- Division of Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Medical Center at Cornell University, New York, NY, USA.
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34
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Yip HK, Wu CJ, Yeh KH, Hang CL, Fang CY, Hsieh KY, Fu M. Unusual complication of retrograde dissection to the coronary sinus of valsalva during percutaneous revascularization: a single-center experience and literature review. Chest 2001; 119:493-501. [PMID: 11171728 DOI: 10.1378/chest.119.2.493] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND While coronary dissection, which is one of the most frequently occurring complications during interventional procedures, has various forms, extensive coronary dissection retrograde to the coronary sinus of Valsalva (CSV) is very rarely observed. METHODS AND RESULTS Within the last 5 years, we retrospectively reviewed our experience with 4,700 consecutive patients who underwent angioplasty procedures, 7 of whom (0.15%) developed extensive coronary dissection retrograde to the CSV. Six of the seven patients developed retrograde dissection of the right CSV during angioplasty to the right coronary artery. One of the seven patents developed retrograde dissection of the left CSV during angioplasty to the left anterior descending artery. Retrograde dissection, which extended to the ascending aorta in two patients, was observed by transthoracic echocardiography and surgical findings, respectively. Five patients were successfully treated by coronary stenting. However, this complication caused four patients to have acute myocardial infarctions, resulting in emergency surgery for one patient and in-hospital death for another. CONCLUSIONS Our experience increased our understanding of this very rare complication. However, this complication may be life threatening, and patients in this clinical setting may have a potential risk for acute myocardial infarction, emergency surgery, or even sudden cardiac death. Therefore, it is important to learn how to promptly diagnose and manage this complication.
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Affiliation(s)
- H K Yip
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan, Republic of China
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35
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Abstract
We set out to determine the incidence of iatrogenic coronary artery dissection extending into the aorta and to characterize the aortic lesions. We reviewed the data from 43,143 cardiac catheterizations from September 1993 through September 1999 and found 9 coronary artery-aortic dissections for an overall incidence of 0.02%. Four of these patients were undergoing treatment for acute myocardial infarction (AMI) and aortic dissection was more common than for non-AMI patients (0.19% vs. 0.01%, P < 0.0006). Histologic analysis of tissue samples from 2 cases revealed age related changes only and no evidence of predisposing pathology. Patients with limited aortic involvement were successfully managed with stenting of the coronary dissection entry point whereas aortic dissection extending up the aorta >40 mm from the coronary os required surgical intervention.
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Affiliation(s)
- D W Dunning
- Division of Cardiology, Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
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36
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Vilacosta I, de Dios RM, Pinto AG. Aortic intramural hematoma during coronary angioplasty: insights into the pathogenesis of intramedial hemorrhage. J Am Soc Echocardiogr 2000; 13:403-6. [PMID: 10804438 DOI: 10.1016/s0894-7317(00)70010-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of a 74-year-old woman who had an aortic intramural hematoma as a complication of percutaneous coronary angioplasty. Transesophageal echocardiography enabled the diagnosis of aortic intramural hematoma and was very useful in the patient's management and follow-up.
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Affiliation(s)
- I Vilacosta
- Departments of Cardiology and Cardiac Surgery, Hospital Ruber Internacional, Madrid, Spain
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37
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Okamoto R, Makino K, Saito K, Miyahara M, Okamoto S, Kouji T, Isaka N, Nakano T. Aorto-coronary dissection during angioplasty in a patient with myxedema. JAPANESE CIRCULATION JOURNAL 2000; 64:316-20. [PMID: 10783057 DOI: 10.1253/jcj.64.316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 67-year-old man with overt hypothyroidism and medically controlled hypertension was admitted for coronary angiography because of exertional angina. His triiodothyronine (T3) and thyroxine (T4) levels had been low for 4 years. Although signs and symptoms of hypothyroidism were apparent, his hypercholesterolemia was mild. Coronary angiography revealed an eccentric stenosis in the distal portion of the right coronary artery and it was decided to perform angioplasty because his angina had continued in spite of medication. The dissection appeared at the lesion site after the first nominal inflation, and a subsequent image disclosed a spiral dissection from the dilated site to the aortic sinus and peripheral coronary artery. Although emergency stenting could not prevent the extension near the origin of the brachiocephalic artery, the false lumen thrombosed and then diminished with conservative therapy. Aorto-coronary dissection is potentially life-threatening and has been recently reported as a complication during cardiac catheterization procedures. Chronic hypothyroid insufficiency may be one of the risk factors for this complication.
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Affiliation(s)
- R Okamoto
- First Department of Internal Medicine, Mie University, Tsu, Japan.
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38
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Al-Saif SM, Liu MW, Al-Mubarak N, Agrawal S, Dean LS. Percutaneous treatment of catheter-induced dissection of the left main coronary artery and adjacent aortic wall: a case report. Catheter Cardiovasc Interv 2000; 49:86-9; discussion 90. [PMID: 10627376 DOI: 10.1002/(sici)1522-726x(200001)49:1<86::aid-ccd20>3.0.co;2-f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Left main coronary artery dissection complicating selective coronary angiography is uncommon. Moreover, aortic root dissection associated with coronary intervention is underreported and may require urgent surgical intervention. During percutaneous coronary angioplasty of a catheter-induced left main coronary artery dissection, retrograde dissection of the adjacent aortic root occurred. Both were successfully treated by stenting of the left main coronary artery. Cathet. Cardiovasc. Intervent. 49:86-89, 2000.
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Affiliation(s)
- S M Al-Saif
- Interventional Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
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39
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Mendzelevski B, Sigwart U. Management of aortic dissection complicating coronary intervention. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:491-2. [PMID: 9554790 DOI: 10.1002/(sici)1097-0304(199804)43:4<491::aid-ccd34>3.0.co;2-k] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Ruda-Vega M. Aortic dissection--exceedingly rare complication of coronary angioplasty. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 42:416. [PMID: 9408626 DOI: 10.1002/(sici)1097-0304(199712)42:4<416::aid-ccd17>3.0.co;2-h] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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