Iatrogenic Dissection of the Right Coronary Artery during Diagnostic Coronary Angiography: A Case Report

Driss Britel

Department of Cardiology, Mohammed V Military Instruction Hospital, Rabat, Morocco and Medecine and Pharmacy Faculty, Mohammed V University of Rabat, Morocco.

Nabil Laktib

Department of Cardiology, Mohammed V Military Instruction Hospital, Rabat, Morocco and Medecine and Pharmacy Faculty, Mohammed V University of Rabat, Morocco.

Soumaila Nikièma *

Department of Cardiology, Mohammed V Military Instruction Hospital, Rabat, Morocco and Medecine and Pharmacy Faculty, Mohammed V University of Rabat, Morocco.

Zouhair Lakhal

Department of Cardiology, Mohammed V Military Instruction Hospital, Rabat, Morocco and Medecine and Pharmacy Faculty, Mohammed V University of Rabat, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Iatrogenic coronary dissection is a mechanical rupture of a coronary wall during coronary angiography or angioplasty. It is a rare but serious complication that can rapidly lead to the death of the patient. We report the case of a young 35 year old patient with only active smoking as a cardiovascular risk factor who presented during a coronary angiography for a STEMI a conduction disorder and hemodynamic instability revealing an iatrogenic dissection of the right coronary artery. Several predisposing factors for iatrogenic coronary artery dissection have been described in the literature, including female gender and deep intubation of the artery. It mainly involves the right coronary artery due to its specific anatomical characteristics. The diagnosis is made on coronary angiography. Management differs according to the haemodynamic state of the patient and the classification of the coronary dissection. Stenting, coronary artery bypass grafting or even conservative treatment may be proposed.

Keywords: Iatrogenic, coronary artery, dissection


How to Cite

Britel , Driss, Nabil Laktib, Soumaila Nikièma, and Zouhair Lakhal. 2023. “Iatrogenic Dissection of the Right Coronary Artery During Diagnostic Coronary Angiography: A Case Report”. Asian Journal of Cardiology Research 6 (1):99-105. https://journalajcr.com/index.php/AJCR/article/view/143.

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References

Yip H-K, Wu C-J, Yeh K-H, Hang C-L, Fang C-Y, Hsieh KY-K, et al. Unusual complication of retrograde dissection to the coronary sinus of Valsalva during percutaneous revascularization. Chest. 2001;119(2):493–501.

Wadalla H, Sabet S, El Sebaie A, et al. Catheterinduced left main dissection incidence, predisposition and therapeutic strategies experience from two sides of the hemisphere. J Invasive Cardiol. 2005;17: 233-6.

Sanchez-Jimenez E, Levi Y, Roguin A. Iatrogenic aortocoronary dissection during right coronary artery procedures: A systematic review of the published literature. Journal of the Society for Cardiovascular Angiography & Interventions. 2022;1(6):100443.

Fischman DL, Vishnevsky A. Management of iatrogenic coronary artery dissections. JACC: Case Reports. 2021;3(3):385–7.

Boyle AJ, Chan M, Dib J, Resar J. Catheter-induced coronary artery dissection: risk factors, prevention and management. J Invasive Cardiol. 2006;18: 500–3.

Andreou AY. Catheter-induced coronary artery dissection: The role of exhalation during contrast medium injection. Cor et Vasa. 2019;61(5):547–50.

Ramasamy A, Bajaj R, Jones DA, Amersey R, Mathur A, Baumbach A, et al. Iatrogenic catheter‐induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years. Catheterization and Cardiovascular Interventions. 2020;

Bansal V, Mishra AK, Kumar R, Kumar B, Barwad P, Chakraborty NS, et al. Emergency valve preserving ascending aorta replacement following iatrogenic right coronary artery dissection: A life‐saving procedure. Journal of Cardiac Surgery. 2020;35(8):2059–63.

Radu MD, Räber L, Heo J, Gogas BD, Jørgensen E, Kelbæk H, et al. Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation. EuroIntervention. 2014;9(9):1085–94.

Dorros G, Cowley M, Simpson J. National Heart, lung and blood institute registry report of complications of percutaneous transluminal coronary angioplasty. The American Journal of Cardiology. 1981;47: 396.

Dunning DW, Kahn JK, Hawkins ET, O'Neill WW. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheterization and Cardiovascular Interventions. 2000;51(4): 387–93.

Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seiler C, et al. Iatrogenic left main coronary artery dissection: Incidence, classification, management, and long-term follow-up. American Heart Journal. 2010;159(6): 1147–53.

Oda H, Hatada K, Sakai K, Takahasi K, Miida T, Higuma N. Aortocoronary dissection resolved by coronary stenting guided by intracoronary ultrasound. Circ J. 2004;68(4):389–391.

Abdou SM, Wu CJ. Treatment of aortocoronary dissection complicating anomalous origin right coronary artery and chronic total intervention with intravascular ultrasound guided stenting. Catheter Cardiovasc Interv. 2011;78(6): 914–919.

Rogers JH, Lasala JM. Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol. 2004;16(9):493-499.

Nguyen T, Hu D, Chen SL, et al. Practical Handbook of Advanced Interventional Cardiology: Tips and Tricks. 4th edition. Oxford, UK: WileyBlackwell, Harding SA, Fairley SL. Cath. 2013;7:353–60.

Celik M, Yuksel UC, Yalcinkaya E, Gokoglan Y, Iyisoy A. Conservative treatment of iatrogenic left main coronary artery dissection: report of two cases. Cardiovasc Diagn Ther. 2013;3(4):244-6.

DOI: 10.3978/j.issn.2223-3652.2013.10.04 PMID: 24400208; PMCID: PMC3878113.

Lee SW, Hong MK, Kim YH, et al. Bail- out stenting for left main coronary artery dissection during catheterbased procedure: Acute and long-term results. Clin Cardiol. 2004;27:393-5.