E-SCIENCE STATION

CASE20230809_001

Complication Management: Aortic Dissection by Percutaneous Coronary Intervention “Watch-And-Wait”

By Huynh Quoc Hieu

Presenter

Huynh Quoc Hieu

Authors

Huynh Quoc Hieu1

Affiliation

HSIC, VNHA, Vietnam1,
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CASE20230809_001
Complication Management - Complication Management

Complication Management: Aortic Dissection by Percutaneous Coronary Intervention “Watch-And-Wait”

Huynh Quoc Hieu1

HSIC, VNHA, Vietnam1,

Clinical Information

Relevant Clinical History and Physical Exam

The 60 -year- old female patient. She was hospitalized with persistent chest pain on exertion. She did the EST Treadmill in Singapore, which is unusual. She was advised to consult a cardiologist for further evaluation. She came to our hospital to continue her treatment as plannedPhysical exam:HR: 75 bpmBP: 125/70 mmHg.She was still on and off  chest discomfort during normal activities. She was indicated for coronary angiogramEcho: EF 70%. No RWMA.


Relevant Test Results Prior to Catheterization

Coronary angiography with significant RCA lesion
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Relevant Catheterization Findings

PCI right coronary artery, pre dilated balloon, noted aortic dissection 
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Interventional Management

Procedural Step

According to the classification of aortic dissection in coronary intervention.We have consider: put cover-stent in  ostial RCA ?call surgery team to activate OT ? or  watch and wait ?This is dissection of the retrograde aorta, we  continued to stenting right coronary. Explain to patient’s family regarding interventional event. She should be follow in ICU; •proceed controlled BP <120/80 mmHg and HR around 60 bpm.We have daily ICU monitoring by echocardiography and MSCT aorta was done which  no issue result, maintained DAPT (Clopidogrel and ASA) . After that, she was discharged from the hospital in stable condition.
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Case Summary

- Acute aortic dissection during PCI remains a very rare complication, with an overall incidence of 0.02%- Retrograde spread of a coronary artery dissection due to mechanical trauma by instruments used such as a guide catheter, wire, inflated balloon, etc. And calcified aorta has also been suggested to be a risk factor for this complication- GradeI and II patients  with limited involvement of the aorta can benefit from stenting of the coronary dissection without  surgical intervention