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      Identification and Management of Iatrogenic Aortocoronary Dissection

      , MD, PhD, FESC, FSCAI , 1 , , MD 1

      Cardiovascular Innovations and Applications


      coronary catheterizations, complication, dissection, iatrogenic diseases, stenting

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          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.

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          Most cited references 32

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          Iatrogenic aortic dissection complicating percutaneous coronary intervention for chronic total occlusion

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            [Structural features of the sinus of valsalva and the proximal portion of the coronary arteries: their relevance to retrograde aortocoronary dissection].

            Retrograde aortocoronary dissection is an unusual complication of coronary angioplasty. Our study provides new structural details of the aortic sinuses and the proximal portions of the coronary arteries, which enable better understanding of several clinical features associated with this complication.
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              Mortality related to diagnostic cardiac catheterization. The importance of left main coronary disease and catheter induced trauma.

              The mortality of diagnostic catheterization is very low but still exists. Large series have documented left main disease as the most important anatomical risk factor but have not clarified the mechanism.

                Author and article information

                1Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
                Author notes
                Correspondence: Shao-Ping Nie, MD, PhD, FESC, FSCAI, Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China, Tel.: +86-10-84005256, Fax: +86-10-64439768, E-mail: spnie@
                Cardiovascular Innovations and Applications
                Compuscript (Ireland )
                May 2016
                July 2016
                : 1
                : 3
                : 343-350
                cvia20160018 10.15212/CVIA.2016.0018
                Copyright © 2016 Cardiovascular Innovations and Applications

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See



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