Incidence, Management, Immediate and Long-Term Outcomes Following Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures
Background—Aortic dissection type A is a high mortality disease. Iatrogenic aortic dissection after interventional procedures is infrequent and prognostic data are scarce. Our objective was to analyze its incidence, patient profile and long-term prognosis.
Methods and Results—Between 2000 and 2014, we retrospectively analyzed 74 patients with dissection of the ascending aorta. Clinical and procedural data were reviewed and later, we performed a prospective clinical follow-up by telephone or in office. We recorded 74 patients. Incidence was 0.06%. Our patients, predominantly male (67.6%) had a mean age of 66.9±10.8years. With multiple cardiovascular risk factors, the main cause for cardiac catheterization was an acute coronary syndrome, in 54. The complication was detected acutely in all, trying to engage the right coronary artery in 47, the left main in 30 and after other maneuvers in 2, mostly in complex therapeutic procedures (78.4%). A coronary artery was involved in 45 patients (60.8%). Thirty five patients underwent an angioplasty and stent implantation, 3 cardiac surgery and 36 were managed conservatively. Two patients died of cardiogenic shock after the dissection. After a median follow-up of 51.2 (16.4-104.8) months, none of the remaining patients developed complications due to the dissection, progression, ischemia, pain or dissection recurrence.
Conclusions—Iatrogenic catheter dissection of the aorta is a rare complication that carries an excellent short and long-term prognosis, adopting a conservative approach. When a coronary artery is involved as an entry point, usually it can be safely sealed with a stent with good long-term outcomes.
- Received January 6, 2015.
- Revision received March 16, 2015.
- Accepted April 10, 2015.