Key result
Failed bail-out stenting for iatrogenic aortocoronary dissection is strongly linked to mortality.
Why the study?
Iatrogenic aorto-coronary dissection is a rare but potentially fatal complication of interventional cardiology requiring better characterization and management strategies.
What are the clinical features, management strategies, and outcomes of iatrogenic aorto-coronary dissection?
Systematic Review (n=125)
What are the clinical features, management strategies, and outcomes of iatrogenic aorto-coronary dissection?
Answers are grounded in this paper and cite their sources.
Bail-out stenting is the most common and critical exit strategy for iatrogenic aorto-coronary dissection, requiring rapid recognition and a shock team approach to prevent mortality.
OBJECTIVES AND BACKGROUND: Iatrogenic aorto-coronary dissection (ICD) is one of the most feared complications of interventional cardiology. Although rare, it is characterized by anterograde coronary ischemia and a concomitant aortic dissection, with potentially fatal consequences. METHODS: We present an example case of IACD and an accurate case-series review of the literature including 125 published cases. RESULTS: There were no significant predisposing factors and the IACD occurred equally in elective and urgent procedures. A significant number of IACDs were associated with CTO procedures. The factors associated with a worse outcome were hemodynamic instability, the presence of anterograde ischemia, and the extent of dissection according to the Dunning classification. Bail-out stenting was the most used strategy and its failure was associated with mortality. CONCLUSION: The main features of IACD are anterograde ischemia, retrograde dissection, and hemodynamic instability, each of them should be addressed with no time delay, possibly with bailout stenting, the most employed exit-strategy. According to our proposed algorithm, a shock team approach is required to coordinate the interdisciplinary skills and enabled patients to receive the best treatment.
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Cereda et al. (2020) conducted a systematic review in Iatrogenic aorto-coronary dissection (n=125). Bail-out stenting was evaluated on Mortality and clinical outcomes. In a systematic review of 125 cases, bail-out stenting was the most frequently used strategy for iatrogenic aorto-coronary dissection, with its failure being associated with mortality.
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