Aortic dissection as complication of percutaneous transluminal coronary angioplasty

Moles, Victor P.; Chappuis, François; Simonet, F; Urban, Philip; Serna, Fernando de la; Ak, Pande; Meier, Bernhard

doi:10.1002/ccd.1810260103

Cited by 65 publications

(42 citation statements)

References 5 publications

(3 reference statements)

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“…In the present case, the trigger for the AD was thought to be a coronary dissection caused by the tip of the guiding catheter, which damaged the ostium of the RCA. Extension of the coronary dissection to the Valsalva sinus and the ascending aorta was possibly the result of raised coronary flow pressure from the contrast injection (1,2).…”

Section: Discussionmentioning

confidence: 99%

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Successful endovascular treatment of iatrogenic coronary artery dissection extending into the entire ascending aorta

Park¹,

Min²,

Cho³

et al. 2008

Canadian Journal of Cardiology

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C oronary artery dissection is a well-known complication of coronary angiography and angioplasty. Infrequently, iatrogenic coronary dissection may result in retrograde extension into the ascending aorta and further (1-3). Iatrogenic aortic dissections (ADs) that are localized a few centimetres beyond the aortic valve may be treated by sealing the entry point by means of coronary stenting (4). However, an extensive dissection involving the ascending aorta may be lifethreatening and often requires urgent surgical intervention (3,5). We report a case of iatrogenic coronary dissection extending into the entire ascending aorta that was successfully resolved by coronary stenting at the entry point. CASE PRESENTATIONA 68-year-old woman with hypertension, diabetes and dyslipidemia was admitted for effort angina for four months. She was taking acetylsalicylic acid, amlodipine, carvedilol, atorvastatin and glimepiride. The technetium-99m sestamibi scan showed severe reversible ischemia at the inferior and posterolateral wall. Coronary angiography via the femoral approach revealed chronic total occlusion (CTO) in the mid-portion of the right coronary artery (RCA) ( Figure 1A). There were other significant stenoses without occlusions in the mid-portion of the left anterior descending artery and the distal site in the left circumflex artery. The left anterior descending artery and left circumflex artery supplied good collateral flow to the occluded RCA.Percutaneous coronary intervention (PCI) to the CTO of the RCA was planned. A loading dose of clopidogrel (300 mg) was given orally and an intravenous bolus of heparin (10,000 IU) was administered. A 7 Fr JR4 guiding catheter was engaged in the ostium of the RCA. Before attempting to pass the wire, contrast medium was injected; this revealed a dissection of the proximal RCA ( Figure 1B). A 0.014 in guidewire (Whisper; Guidant Corporation, USA) was successfully passed down into the distal RCA across the total occlusion. However, a follow-up angiogram showed progression of the dissection into the sinus of Valsalva ( Figure 1C), and the patient suddenly complained of anterior chest pain and back pain without ST segment change on the electrocardiogram. Hemodynamic conditions were stable. After predilation with a 1.5 mm balloon, a 3.0 mm × 18 mm Driver stent (Medtronic Inc, USA) was implanted in the CTO lesion. A second Driver stent (3.5 mm × 24 mm) was implanted in the ostium of the RCA to seal off the entry point of the dissection, proximally to the first stent. A follow-up angiogram demonstrated no residual stenosis in the stented segment with good distal flow and no further extravasation of contrast medium ( Figure 1D). However, persistent contrast staining was observed along the aortic wall of the ascending aorta up to the aortic arch on the final angiogram (Figure 2). Because the patient was stabilized after stent implantation and the AD was stable, apparently with no progression, conservative management was decided.A computed tomography scan performed immediately after the P...

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Section: Discussionmentioning

confidence: 99%

“…Infrequently, iatrogenic coronary dissection may result in retrograde extension into the ascending aorta and further (1)(2)(3). Iatrogenic aortic dissections (ADs) that are localized a few centimetres beyond the aortic valve may be treated by sealing the entry point by means of coronary stenting (4).…”

mentioning

confidence: 99%

Successful endovascular treatment of iatrogenic coronary artery dissection extending into the entire ascending aorta

Park¹,

Min²,

Cho³

et al. 2008

Canadian Journal of Cardiology

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“…Investigations continue into the use of bare metal [2] and drug-eluting stents [3][4][5][6][7][8] in combination with antiplatelet therapy and aspirin. As is well known, coronary angioplasty carries certain risks of complications ranging from benign rupture to catastrophic events [9][10][11][12][13][14][15][16][17][18]. In a large research study [9], one or more acute major complications arose in 34 of 500 cases (6.8%).…”

Section: Introductionmentioning

confidence: 99%

State of the Art in Cardiac Intervention: A Case Report

Allen¹

2012

IJCM

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The first acute myocardial infarction (MI) of an elderly male was determined through angiography to be due to an infarct of the circumflex artery. The angiogram also revealed chronic occlusion and diffuse disease of the left anterior descending artery (LAD). This had been compensated for by collateral circulation from the right coronary artery. Since the patient had no prior history of coronary artery disease, the chronic and collateralized disease of the LAD was presumed to be stable and this artery was not treated. Due to a history of aspirin intolerance a bare metal stent was implanted in the circumflex artery. Within hours after stenting the patient had a second acute MI. Despite no change in the angiogram, the EKG suggested that the LAD was the source of the second MI. Indeed, a drug-eluting stent implanted in the LAD resolved the patient's signs and symptoms and he was discharged with a favorable outcome. The surprising second MI and the inconsistent stenting illustrate that when the unexpected occurs, there is no substitute for the judgment of a skilled clinician.

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“…The trigger for aortocoronary dissections is a coronary dissection, which extends progressively into the coronary sinus of Valsalva and the ascending aorta. [1][2][3][4] We report a case of iatrogenic coronary dissection extending into the ascending aorta that was successfully resolved by ICUSguided coronary stenting. …”

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Aortocoronary Dissection Resolved by Coronary Stenting Guided by Intracoronary Ultrasound

Oda

Hatada

Sakai

et al. 2004

Circ J

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ortocoronary dissection is a rare complication of percutaneous coronary intervention (PCI). The trigger for aortocoronary dissections is a coronary dissection, which extends progressively into the coronary sinus of Valsalva and the ascending aorta. [1][2][3][4] We report a case of iatrogenic coronary dissection extending into the ascending aorta that was successfully resolved by ICUSguided coronary stenting. Case ReportA 70-year-old male was admitted for unstable angina. He had a past history of cerebral infarction and pulmonary silicosis for which he needed home oxygen therapy. Coronary angiography (CAG) revealed 2 chronic total occlusions (CTO): a proximal site in the dominant right coronary artery (RCA), and a distal site in the circumflex artery. There were other significant stenoses without occlusions in the mid-portion of the left anterior descending artery (LAD) and the diagonal branches. The diseased LAD supplied good collateral flow to the occluded RCA. Thallium-201 myocardial scintigraphy showed ischemia in the anteroseptal and inferior walls. He agreed to undergo PCI, because he was a high-risk patient for coronary bypass surgery with his reduced pulmonary function capacity.PCI to the CTO of the RCA was planned. The Amplatzs L-1 7Fr catheter was engaged in the ostium of the RCA, but manipulation of the guide wire in the catheter was difficult and it was exchanged for a Judkins-right 4. A 0.014-inch guide wire was able to cross the occlusion, but it was difficult with a balloon catheter because the lesion was very hard. Using more back-up force, the tip of the guide catheter was advanced closer to the CTO while rotating it clockwise, and as the balloon catheter was advanced to the CTO, the guide catheter was rotated a little counter clock-wise. The balloon catheter was pushed strongly while keeping Circulation Journal Vol.68, April 2004 the tip of the guide catheter in the RCA, and it successfully passed the hard lesion. After dilating the CTO, contrast injections to the RCA revealed a large dissection from where the tip of the guide catheter contacted RCA to the right coronary cusp (RCC). Balloon angioplasty with a 3.0-mm balloon was performed for the CTO and the dissection, while the guiding catheter was dislodged from the ostium and contrast injections were gently done. The area in the RCC dyed by contrast medium widened (Fig 1B), and the patient suddenly complained of anterior chest pain and back pain without ST change on the electrocardiogram. ICUS was immediately performed to get more information than was shown by CAG. ICUS (Fig 2) showed an entry point of a large dissection in the proximal RCA, which Circ J 2004; 68: 389 -391 (Received March 20, 2002; revised manuscript received August 8, 2002; accepted August 29, 2002) The Department of Cardiology, Niigata City General Hospital, Niigata, Japan Mailing address: Hirotaka Oda, MD, The Department of Cardiology, Niigata City General Hospital, 2-6-1 Shichikuyama, Niigata 950-8739, Japan. E-mail: oda@hosp.niigata.niigata.jp

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Aortic dissection as complication of percutaneous transluminal coronary angioplasty

Cited by 65 publications

References 5 publications

Successful endovascular treatment of iatrogenic coronary artery dissection extending into the entire ascending aorta

Successful endovascular treatment of iatrogenic coronary artery dissection extending into the entire ascending aorta

State of the Art in Cardiac Intervention: A Case Report

Aortocoronary Dissection Resolved by Coronary Stenting Guided by Intracoronary Ultrasound

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