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Case Reports
. 2008 Nov;24(11):857-9.
doi: 10.1016/s0828-282x(08)70196-x.

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

Il-Woon Park  1 , Pil-Ki Min, Deok-Kyu Cho, Ki-Hyun Byun
Affiliations
Case Reports

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

Il-Woon Park et al. Can J Cardiol. 2008 Nov.

Abstract
in English, French

Iatrogenic acute dissection of the ascending aorta during percutaneous coronary intervention occurs rarely. Localized aortic dissections may be treated by sealing the entry with a coronary stent. However, extensive dissections may require a surgical intervention. A case of iatrogenic coronary dissection with extensive propagation into the ascending aorta during angioplasty of the right coronary artery is presented. The aortic dissection was successfully treated by stenting at the right coronary artery ostium. Follow-up computed tomography and coronary angiography showed complete resolution of aortic dissection.

Une dissection iatrogène aiguë de l’aorte ascendante durant une intervention coronarienne percutanée est un événement rare. Les dissections aortiques localisées peuvent être traitées en obturant le point d’entrée au moyen d’une endoprothèse coronarienne. Toutefois, les dissections importantes peuvent nécessiter une intervention chirurgicale. On présente ici un cas de dissection coronarienne iatrogène avec propagation dans toute l’aorte ascendante durant une angiographie de la coronaire droite. La dissection aortique a été réalisée avec succès par endoprothèse à l’embouchure de la coronaire droite. La tomographie et la coronarographie de suivi ont montré une résolution complète de la dissection aortique.

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Figures

Figure 1)
Figure 1)
Coronary angiogram. A Left anterior oblique view showing total occlusion in the mid-portion of the right coronary artery (RCA). B After engagement of the guiding catheter, a dissection of the proximal RCA was developed. C Right anterior oblique view showing progression of the dissection into the sinus of Valsalva (arrow). D Follow-up angiogram after coronary stenting demonstrating no residual stenosis in the stented segment, with good distal flow
Figure 2)
Figure 2)
Persistent contrast staining was observed along the aortic wall of the ascending aorta up to the aortic arch (arrows) on the final cineradiography after percutaneous coronary intervention
Figure 3)
Figure 3)
Computed tomography performed after the coronary intervention showing complete resolution of the dissection. No intimal flap was observed in the ascending aorta (arrow) or aortic arch (arrowheads)
Figure 4)
Figure 4)
Follow-up angiogram performed the next day, demonstrating no residual contrast staining of the aortic wall and no further extravasations of contrast medium
See this image and copyright information in PMC

References

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