Iatrogenic Ascending Aorta Dissection during Diagnostic Coronary Angiography: Rare but Life-Threatening

Type A aortic dissection during diagnostic coronary angiography in normal coronary arteries: A case report

KEY CLINICAL MESSAGE

Aortic dissection is one of the rare complication of coronary angiography. The main treatment underlies surgical intervention however; management should be done with patient's decision.

ABSTRACT

Coronary angiography (CA) is a widely utilized diagnostic procedure used to evaluate blood flow through the coronary arteries and detect coronary artery disease (CAD). Despite its widespread use, it has complications including non-life-threatening, while there are some rare complications that can occur. We present a case of an elderly woman who presented with ST elevation myocardial infarction (STEMI) and underwent CA without evidence of CAD. However, the patient later developed type A aortic dissection (AD) as a complication of the procedure. Surgery is considered emergent treatment for type A-AD, but the patient was asymptomatic without any complaint, shared decision making was conducted and the patient decided to pursue conservative treatment without surgical intervention. Therefore, managing AD should be tailored to each patient individually through shared-decision making.

Acute Limb Ischemia Caused by Dissection following Percutaneous Coronary Intervention Using Right Radial Approach

Iatrogenic aortic dissection is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Iatrogenic aortic dissection following PCI is rare with most cases reporting dissection originating within the coronary vessels with propagation into the ascending aorta. In this specific case, dissection was without coronary involvement, with dissection extending from the ascending aorta into the descending aorta and iliac vessels. Although PCI via radial approach is associated with fewer vascular complications than with femoral approach, significant adverse outcomes may still occur and require prompt intervention. This case highlights the highly atypical presentation of iatrogenic aortic dissection following cardiac catheterization presenting as acute limb ischemia. In such patients as with ours, immediate surgical intervention is necessary with overall poor prognosis.

Iatrogenic Aortic Dissection Presenting With Leg Pain Diagnosed With Point-of-care Ultrasound

Iatrogenic aortic dissection (IAD) status-post-cardiac catheterization is a rare complication often isolated to the proximal aorta. This is a case of IAD isolated to the distal aorta in a 41-year-old female who presented to the emergency department with right leg pain after undergoing three cardiac catheterizations. The diagnosis of IAD was made upon discovery of an intimal flap in the distal aorta and femoral artery while performing a point-of-care ultrasound to evaluate for deep vein thrombosis.

Late Presentation of Aortic Aneurysm and Dissection Following Cardiac Catheterization

We report a 63-year-old female with hypertension, hyperlipidemia, and prior pacemaker insertion for atrial fibrillation with symptomatic bradycardia, who was admitted with substernal chest pressure and diaphoresis. Her electrocardiogram revealed atrial fibrillation with demand ventricular pacing and her cardiac biomarkers were negative for acute coronary syndrome. Echocardiogram revealed normal left ventricular systolic function and normal aortic root diameter. Coronary angiography revealed 60-70% obtuse marginal lesion, otherwise mild disease. She was treated medically and discharged in stable condition. She was readmitted 1 month later with recurring chest pain, and shortness of breath which started shortly after her most recent discharge. Blood pressure was 152/93 mm Hg, and heart rate was 105 bpm. BNP was elevated at 1,400 pg/mL, and other cardiac biomarkers were negative. She was treated with diuretics, which resulted in decrease of her blood pressure to 81/51 mm Hg. Repeat echocardiogram revealed severely dilated aortic root, measuring 6.7 cm, with aortic dissection flap and moderate to severe aortic regurgitation. CT angiogram revealed aortic dissection extending proximally to the aortic root above the coronary ostia and distally to the left subclavian artery takeoff. She underwent surgery; she, however, could not be weaned off from cardiopulmonary bypass and died in the operating room. This case illustrates the importance of having a high index of suspicion for iatrogenic aortic dissection following cardiac catheterization as a cause of recurrence of cardiac symptoms, as early detection may help avert a catastrophic outcome, as we report in our patient.