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. 2014 Oct 1;84(4):670-5.
doi: 10.1002/ccd.25338. Epub 2013 Dec 23.

Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systematic review of the literature

Deborah Shorrock  1 , Tesfaldet T Michael, Vishal Patel, Anna Kotsia, Bavana V Rangan, Shuaib A Abdullah, Jerrold M Grodin, Avantika Banerjee, Emmanouil S Brilakis
Affiliations

Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions: a case series and systematic review of the literature

Deborah Shorrock et al. Catheter Cardiovasc Interv. .

Abstract

Background: Aortocoronary dissection can complicate percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs).

Methods: We retrospectively examined the frequency and outcomes of aortocoronary dissection among 336 consecutive CTO PCIs performed at our institution between 2005 and 2012 and performed a systematic review of the published literature.

Results: Aortocoronary dissection occurred in six patients (1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections occurred in the right coronary artery (CTO target vessel in five patients and donor vessel in one patient). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar. Compared to patients without, those with aortocoronary dissection were more likely to undergo crossing attempts using the retrograde approach (25% vs. 67%, P = 0.036) and experience a major complication (2.4% vs. 33.3%, P = 0.008). Technical and procedural success rates were similar in both groups. Of the six patients with aortocoronary dissection one underwent emergency coronary bypass graft surgery (CABG), four were treated with ostial stenting, and one was treated conservatively without subsequent adverse clinical outcomes. Systematic literature review provided 107 published cases of aortocoronary dissection during PCI, that occurred mainly in the right coronary artery (74.8%) and were treated with stenting (49.5%), emergency CABG (29%), or conservatively (21.5%).

Conclusions: Aortocoronary dissection is an infrequent complication of CTO PCI and although it can be treated with stents in most patients, it may infrequently require emergency CABG.

Keywords: aortocoronary dissection; chronic total occlusion; complications; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Coronary angiography demonstrating chronic total occlusion of the proximal right coronary artery using single (arrow, panel A) or dual (arrow, panel B) injection. Angiography after successful intervention of the right coronary artery chronic total occlusion demonstrating aortocoronary dissection adjacent to the right coronary artery ostium (arrows, panel C). Trans-esophageal echocardiography at the end of the chronic total occlusion intervention of the right coronary artery demonstrating a dissection in the right coronary cusp (Panel 1D). Repeat trans-esophageal echocardiography performed 1 month later demonstrated resolution of the dissection (Panel 1E).
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