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Neth Heart J. 2010 May; 18(5): 264.
PMCID: PMC2871748

Aortic dissection secondary to coronary artery intervention

A 68-year-old-female presented with acute chest pain, and was found to have an acute coronary syndrome (ACS). Coronary angiography demonstrated a significant lesion in the right coronary artery (RCA). Percutaneous coronary intervention was complicated by guide catheter-induced spiral dissection of the RCA, extending proximally to the coronary cusps and to a portion of the ascending aorta (figure 1). Stenting of RCA dissection was enough to seal the retrograde blood flow to the aortic portion of the dissection. Follow-up echocardiography revealed normal left ventricular function and a normal aortic root.

Figure 1
(A) Left anterior oblique (LAO) cranial view of the RCA showing significant lesion. (B) Catheter-induced antigrade spiral dissection (small arrows). (C) Retrograde extension involving the coronary cusps and portion of the ascending aorta (big arrows). ...

Coronary dissection is a well-known complication of coronary interventions (in our case due to deep seating of the guiding catheter); however, retrograde extension to the aortic root and ascending aorta is exceedingly rare, with an incidence reported as 0.02% of coronary angioplasties.1,2 Conservative management can be sufficient in cases with extension less than four centimetres into the ascending aorta.2-4

Acknowledgment

Both authors contributed equally to the literature search and to the preparation of this manuscript. We have no financial disclosure or conflict of interest to report.

References

1. Ruda-Vega M. Aortic dissection--exceedingly rare complication of coronary angioplasty. Cathet Cardiovasc Diagn. 1997;42:416. [PubMed]
2. Dunning DW, Kahn JK, Hawkins ET, O'Neill WW. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv. 2000;51:387-93. [PubMed]
3. Cheng CC, Tsao TP, Tzeng BH, Cheng SM, Yang SP. Stenting for coronary intervention-related dissection of the left main coronary artery with extension to the aortic root: a case report. South Med J. 2008;101:1165-7. [PubMed]
4. Park IW, Min PK, Cho DK, Byun KH. Successful endovascular treatment of iatrogenic coronary artery dissection extending into the entire ascending aorta. Can J Cardiol. 2008;24:857-9. [PMC free article] [PubMed]

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