Iatrogenic catheter‐induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years

Abstract

Objective We sought to describe the prevalence, management strategies and evaluate the prognosis of patients with iatrogenic catheter‐induced ostial coronary artery dissection (ICOCAD). Background ICOCAD is a rare but potentially devastating complication of cardiac catheterisation. The clinical manifestations of ICOCAD vary from asymptomatic angiographic findings to abrupt vessel closure leading to myocardial infarction and death. Methods 55,968 patients who underwent coronary angiography over a 10‐year period were screened for ICOCAD as defined by the National Heart, Lung, and Blood Institute. The management and all‐cause mortality were retrieved from local and national databases. Results The overall prevalence of ICOCAD was 0.09% (51/55,968 patients). Guide catheters accounted for 75% (n = 37) of cases. Half of the ICOCAD cases involved the right coronary artery while the remaining were related to left main stem (23/51; 45%) and left internal mammary artery (2/51; 4%). Two‐thirds of ICOCAD were high grade (type D, E, and F). The majority of cases were type F dissections (n = 18; 66%), of which two third occurred in females in their 60s. The majority of ICOCAD patients (42/51; 82%) were treated with percutaneous coronary intervention while the remaining underwent coronary artery bypass grafting (3/51; 6%) or managed conservatively (6/51; 12%). Three deaths occurred during the index admission while 48/51 patients (94.1%) were safely discharged without further mortality over a median follow‐up of 3.6 years. Conclusions ICOCAD is a rare but life‐threatening complication of coronary angiography. Timely recognition and prompt bailout PCI is a safe option for majority of patients with good clinical outcomes.

Delayed percutaneous coronary intervention for an extensive iatrogenic left main coronary artery dissection: a case report

“…However, as in our patient’s case, it can also be provoked by suboptimal catheterization techniques, such as deep catheter intubation into LMCA and vigorous manipulations, as well as contrast injections toward the arterial wall [ 1 , 4 ]. JL3.5 diagnostic catheter, which was used in our patient’s angiography, is the second most frequently associated with dissection catheter after EBU3.5 guide [ 5 ]. Owing to JL3.5 catheter’s shape, its tip was “scraping” against the upper arterial wall of our patient’s LMCA, not coaxially engaging the ostium, leading to a type B iatrogenic dissection [ 6 ].…”

Factors associated with aorto-ostial stent coverage during intravascular ultrasound-guided percutaneous coronary intervention to severely narrowed non-ostial right coronary artery lesions

“…We should also discuss why the AL-type guide catheter was inversely associated with ostial stent coverage. In general, the risk of coronary injury is considered to be greater in the AL-type guide catheters than in the Judkins type guide catheters [ 23 , 24 ]. However, our results were contradictory, which requires careful interpretation.…”

Catheter-induced left coronary artery dissection treated with intravascular ultrasound-guided percutaneous coronary intervention

“…Catheter-induced coronary artery dissection (CICAD) is a rare but very serious complication of invasive diagnostics and percutaneous treatment of coronary artery disease. The incidence of CICAD is < 0.1% [ 1 ]. CICAD is usually treated with stent deployment, less often conservatively and only a small percentage of patients require surgical intervention [ 1 , 2 ].…”

“…The incidence of CICAD is < 0.1% [ 1 ]. CICAD is usually treated with stent deployment, less often conservatively and only a small percentage of patients require surgical intervention [ 1 , 2 ].…”