Key result
Percutaneous coronary intervention for spontaneous coronary artery dissection caused a rare type A iatrogenic acute aortic dissection, which was successfully treated with emergency surgery.
Why the study?
Iatrogenic acute aortic dissection caused by cardiovascular intervention is rare, as is spontaneous coronary artery dissection causing acute coronary syndrome.
Case Report (n=1)
This case highlights the rare but severe risk of iatrogenic type A acute aortic dissection during PCI for spontaneous coronary artery dissection, which can be successfully managed with emergency surgery.
Iatrogenic type A AAD may complicate SCAD intervention; leaves open optimal procedural strategies pending further reports.
BACKGROUND: Iatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. Also rare is spontaneous coronary artery dissection (SCAD), a form of acute coronary syndrome, which develops in relatively young women without coronary risk factors. We encountered type A iatrogenic AAD caused by an intervention for SCAD. CASE PRESENTATION: A 53-year-old woman was brought to our hospital after cardiopulmonary resuscitation. She was diagnosed with acute coronary syndrome caused by SCAD, and percutaneous coronary intervention was carried out on her distal left anterior descending artery. The dissection proceeded to the proximal left anterior descending artery and left main coronary artery trunk, so additional percutaneous coronary intervention was performed on the left circumflex artery. After the intervention, type A AAD occurred with a primary entry tear from the left main coronary artery trunk, and computed tomography showed a type A AAD of the aortic arch. We performed emergency ascending aorta replacement and coronary artery bypass grafting to the left anterior descending artery and left circumflex artery. The patient had an uneventful recovery after the operation and was discharged on postoperative day 25. CONCLUSION: To our knowledge, this is the first report of an iatrogenic AAD caused by percutaneous coronary intervention for SCAD.
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Hayashi et al. (2020) conducted a case report in Spontaneous coronary artery dissection (SCAD) and iatrogenic acute aortic dissection (IAAD) (n=1). Percutaneous coronary intervention was evaluated. Percutaneous coronary intervention for spontaneous coronary artery dissection caused a rare type A iatrogenic acute aortic dissection, which was successfully treated with emergency surgery.
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