Identification and Management of Iatrogenic Aortocoronary Dissection
Iatrogenic aortocoronary dissection (IACD) is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly cause...
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doaj-002d24091557425694f2a150fea8dafa2020-11-24T22:18:44ZengCompuscriptCardiovascular Innovations and Applications2009-86182009-87822016-05-011334335010.15212/CVIA.2016.0018Identification and Management of Iatrogenic Aortocoronary DissectionShao-Ping Nie, MD, PhD, FESC, FSCAI0Xiao Wang, MD1Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaEmergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaIatrogenic aortocoronary dissection (IACD) is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures, and appears as luminal filling defects or persistence of contrast (“extraluminal cap”) or intimal tear outside the coronary lumen. Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen. Similarly, it could extend retrogradely into the sinus of Valsalva and cusp, or even the ascending aorta, aortic arch, or descending aorta, leading to hemodynamic collapse. Early identification and prompt management is crucial to the prognosis of patients with IACD. Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection, even when significant propagation has already occurred. Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.http://www.ingentaconnect.com/content/cscript/cvia/2016/00000001/00000003/art00012coronary catheterizationscomplicationdissectioniatrogenic diseasesstenting |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shao-Ping Nie, MD, PhD, FESC, FSCAI Xiao Wang, MD |
spellingShingle |
Shao-Ping Nie, MD, PhD, FESC, FSCAI Xiao Wang, MD Identification and Management of Iatrogenic Aortocoronary Dissection Cardiovascular Innovations and Applications coronary catheterizations complication dissection iatrogenic diseases stenting |
author_facet |
Shao-Ping Nie, MD, PhD, FESC, FSCAI Xiao Wang, MD |
author_sort |
Shao-Ping Nie, MD, PhD, FESC, FSCAI |
title |
Identification and Management of Iatrogenic Aortocoronary Dissection |
title_short |
Identification and Management of Iatrogenic Aortocoronary Dissection |
title_full |
Identification and Management of Iatrogenic Aortocoronary Dissection |
title_fullStr |
Identification and Management of Iatrogenic Aortocoronary Dissection |
title_full_unstemmed |
Identification and Management of Iatrogenic Aortocoronary Dissection |
title_sort |
identification and management of iatrogenic aortocoronary dissection |
publisher |
Compuscript |
series |
Cardiovascular Innovations and Applications |
issn |
2009-8618 2009-8782 |
publishDate |
2016-05-01 |
description |
Iatrogenic aortocoronary dissection (IACD) is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures, and appears as luminal filling defects or persistence of contrast (“extraluminal cap”) or intimal tear outside the coronary lumen. Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen. Similarly, it could extend retrogradely into the sinus of Valsalva and cusp, or even the ascending aorta, aortic arch, or descending aorta, leading to hemodynamic collapse. Early identification and prompt management is crucial to the prognosis of patients with IACD. Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection, even when significant propagation has already occurred. Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise. |
topic |
coronary catheterizations complication dissection iatrogenic diseases stenting |
url |
http://www.ingentaconnect.com/content/cscript/cvia/2016/00000001/00000003/art00012 |
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