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      Successful Bail-Out Stenting for Iatrogenic Right Coronary Artery Dissection in a Young Male

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          Abstract

          A 44-year-old man presented with symptoms of shortness of breath on exertion. The shortness of breath started after walking for 10 min and made him…

          Abstract

          Catheter-induced coronary artery dissection is a serious complication of coronary angiography. Percutaneous intervention is usually indicated in case of large spiral dissections, however, wiring into the true lumen can be challenging. This case reports the novel use of intravascular ultrasound-guided rescue percutaneous coronary intervention for stenting an iatrogenic spiral dissection of the right coronary artery. ( Level of Difficulty: Intermediate.)

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          Spontaneous coronary artery dissection.

          Jacqueline Saw (2013)
          Spontaneous coronary artery dissection (SCAD) is an infrequent condition that is underdiagnosed. There is a predilection for young women without traditional cardiovascular risk factors, and it is increasingly diagnosed in women who are not peripartum. We discovered an association between SCAD and fibromuscular dysplasia (FMD), in which most women with nonatherosclerotic SCAD were found to have FMD in another vascular territory. We suspect that these seemingly healthy patients have underlying coronary FMD that predisposed them to coronary dissection. Medical treatment of SCAD includes antiplatelet therapy and β-blockade. Revascularization of SCAD patients might be challenging, and the recommendation for stenting or surgery depends on their clinical status and the dissected coronary anatomy. The long-term outcome of patients who survived their SCAD event is generally good, however, they are at risk for recurrent dissection and major cardiovascular events, and thus should be closely monitored by cardiovascular specialists. This review summarizes the epidemiology, associated etiology, diagnosis, management, and outcome of patients with SCAD.
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            Catheter-induced coronary artery dissection: risk factors, prevention and management.

            Michelle J. Boyle, Jon Resar, Martin Dib … (2006)
            Guide catheter-induced dissection of the coronary arteries is an uncommon but potentially catastrophic complication of diagnostic and interventional cardiac catheterization. Several factors placing the individual at higher risk of this complication have been identified. We discuss these risk factors and utilize them to propose methods to prevent dissections. Management options of coronary artery dissection are also discussed.
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              Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry

              Takahiro Hiraide, Mitsuaki Sawano, Yasuyuki Shiraishi … (2018)
              Despite the ever-increasing complexity of percutaneous coronary intervention (PCI), the incidence, predictors, and in-hospital outcomes of catheter-induced coronary artery dissection (CICAD) is not well defined. In addition, there are little data on whether persistent coronary flow impairment after CICAD will affect clinical outcomes. We evaluated 17,225 patients from 15 participating hospitals within the Japanese PCI registry from January 2008 to March 2016. Associations between CICAD and in-hospital adverse cardiovascular events were evaluated using multivariate logistic regression. Outcomes of patients with CICAD with or without postprocedural flow impairment (TIMI flow ≤ 2 or 3, respectively) were analyzed. The population was predominantly male (79.4%; mean age, 68.2 ± 11.0 years); 35.6% underwent PCI for complex lesions (eg. chronic total occlusion or a bifurcation lesion.). CICAD occurred in 185 (1.1%), and its incidence gradually decreased (p < 0.001 for trend); postprocedural flow impairment was observed in 43 (23.2%). Female sex, complex PCI, and target lesion in proximal vessel were independent predictors (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.53–3.10; OR, 2.19; 95% CI, 1.58–3.04; and OR, 1.55; 95% CI, 1.06–2.28, respectively). CICAD was associated with an increased risk of in-hospital adverse events (composite of new-onset cardiogenic shock and new-onset heart failure) regardless of postprocedural flow impairment (OR, 10.9; 95% CI, 5.30–22.6 and OR, 2.27; 95% CI, 1.20–4.27, respectively for flow-impaired and flow-recovered CICAD). In conclusion, CICAD occurred in roughly 1% of PCI cases; female sex, complex PCI, and proximal lesion were its independent risk factors. CICAD was associated with adverse in-hospital cardiovascular events regardless of final flow status. Our data implied that the appropriate selection of PCI was necessary for women with complex lesions.
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                Author and article information

                Contributors
                Faisal Hasan
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 21 August 2019
                Publication date Collection: August 2019
                Publication date (Electronic): 21 August 2019
                Volume: 1
                Issue: 2
                Pages: 108-112
                Affiliations
                [1]Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
                Author notes
                [∗ ] Address for correspondence: Dr. Faisal Hasan, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi 112412, United Arab Emirates. hasanF@ 123456clevelandclinicabudhabi.ae
                Article
                Publisher Item ID: S2666-0849(19)30104-4
                DOI: 10.1016/j.jaccas.2019.05.027
                PMC ID: 8301246
                PubMed ID: 34316761
                SO-VID: 44fc9159-5da6-438c-9db8-28113fd132c0
                Copyright © © 2019 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 20 May 2019
                Date accepted : 29 May 2019
                Categories
                Subject: Mini-Focus Issue: Interventional Complications and Their Management
                Subject: Case Report: Clinical Case

                Keywords: iatrogenic coronary artery dissection,intravascular ultrasound,percutaneous coronary intervention,cicad, catheter-induced coronary artery dissection,ivus, intravascular ultrasound,pci, percutaneous coronary intervention,rca, right coronary artery,tl, true lumen,fl, false lumen,bmw, balance middle weight,oct, optical tomography
                Data availability:
                Keywords: iatrogenic coronary artery dissection, intravascular ultrasound, percutaneous coronary intervention, cicad, catheter-induced coronary artery dissection, ivus, intravascular ultrasound, pci, percutaneous coronary intervention, rca, right coronary artery, tl, true lumen, fl, false lumen, bmw, balance middle weight, oct, optical tomography

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