Management of aortic dissection complicating coronary intervention

✍ Scribed by Mendzelevski, Boaz ;Sigwart, Ulrich

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 10 KB
• Volume: 43
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/(sici)1097-0304(199804)43:4<491::aid-ccd34>3.0.co;2-k

✦ Synopsis

We read with great interest the case reports by Alfonso et al. [1]. We would like to add to the sporadic cases published so far a rather unique case of retrograde aortic dissection complicating coronary angioplasty and stenting. A 68-year-old man, with hypercholesterolemia and a history of heavy smoking, was referred for elective coronary angiography due to typical effort angina. Coronary angiography revealed multivessel coronary artery disease with a chronic occlusion of the distal left anterior descending coronary artery (LAD), subtotal occlusion of a significant first diagonal artery (D1), and a flow limiting stenosis of the left circumflex coronary artery (LCx). The right coronary artery was also chronically occluded. The D1 was dilated using a 3 mm balloon inflated to 8 atmospheres with suboptimal result. A 3 mm diameter, 15 mm long MultiLink (ACS-Guidant, Santa Clara, CA) stent was successfully implanted, starting at the ostium. The first contrast injection resulted in dissection and abrupt closure of the left main coronary artery (LMCA). There was retrograde extension and contrast staining of the entire aortic root with cardiogenic shock. The LCx was immediately wired and a second 3.5 mm MultiLink stent implanted into the LMCA and into the proximal LCx. The LM portion of the stent was postdilated to 4 mm. The result was excellent and the LMCA dissection was completely sealed. The LAD ostium was then dilated with a 3 mm balloon through the stent. The patient recovered uneventfully and was discharged the day after without chest pain or evidence of myocardial infarction. A