Dual Percutaneous Management of Dunning Type III Iatrogenic Aortic Dissection During PCI: A Case Report

Figures

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  Figure 1. Angiographic images of dissection and subsequent percutaneous coronary intervention. (A) Baseline angiography: Diffuse proximal-to-mid right coronary artery (RCA) disease with 90% stenosis and distal occlusion. (B) Follow-up angiography: Proximal RCA dissection extending into the ascending aorta with compromised distal flow. (C) Post-procedural angiography: Persistent linear contrast staining at the RCA ostium and within the root of the aortic sinus. (D) Covered stent (CS) deployment: A CS was deployed and post-dilated, successfully sealing the dissection.

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  Figure 2. Intravascular ultrasound (IVUS) images following drug-eluting stent implantation. IVUS reveals a substantial haematoma persisting beneath the stent.

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  Figure 3. Computed tomography (CT) aortography at baseline and at 12-h and 1 month follow-ups. (A) and (D) Preoperative CT imaging: Dissection of the ascending aorta with contrast retention within the haematoma. (B) and (E) Postoperative CT (12 h): Reduction of the haematoma. (C) and (F) One-month follow-up CT: No haematoma observed. (H) Preoperative CT imaging: Involvement of the bilateral carotid arteries with luminal narrowing. (I) Postoperative CT (12 h): Further reduction of the haematoma. (G) One-month follow-up CT: Complete resolution of the haematoma.

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  Figure 4. Procedure analysis. (A) Blood flow entering the tear through the stent struts leads to haematoma expansion and subsequent propagation of the dissection. (B) The covered stent seals the entry tear, thereby preventing the progression of both the haematoma and the dissection.