Key result
Armed surveillance was used to manage a coronarography-induced type A aortic dissection, avoiding complex surgery under major antithrombotic treatment.
Why the study?
Coronary dissection is a rare complication of coronary catheterization without established management recommendations, and immediate surgery carries high risk under major antithrombotic therapy.
Case Report (n=1)
Non-surgical management (armed surveillance) may be a viable alternative to immediate surgery for iatrogenic type A aortic dissection following coronary catheterization, particularly to avoid operating under major antithrombotic treatment.
May support armed surveillance for select iatrogenic type A dissections; leaves open need for prospective validation before practice change.
Coronary dissection is an extremely rare but known complication of coronary catheterization and angioplasty. Due to its rarity, there are no management recommendations. However, surgery immediately after an endovascular procedure is frequently carried out under major antithrombotic treatment. The surgery and the postoperative consequences are therefore very complex. We report here the documented case of a type A aortic dissection after coronary catheterization. Despite extension to the entire ascending aorta which indicated surgical management, the benefit-risk balance argued for armed surveillance to avoid surgery under antiplatelets drugs without known antidote. We believe this case should lead us to systematically weigh the data before considering that any iatrogenic dissection of Dunning class 3 should be operated.
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D’Ostrevy et al. (2021) conducted a case report in Coronarography-induced iatrogenic aortic dissection (n=1). Armed surveillance (non-surgical treatment) was evaluated. Armed surveillance was used to manage a coronarography-induced type A aortic dissection, avoiding complex surgery under major antithrombotic treatment.
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