Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation.
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SUBMITTER: Aikawa T
PROVIDER: S-EPMC8904324 | biostudies-literature | 2022 May-Jun
REPOSITORIES: biostudies-literature
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Treatment of an iatrogenic left main coronary artery dissection and intramural hematoma by fenestration instead of stent implantation.
Aikawa Tadao T Funayama Naohiro N Sunaga Daisuke D Furugen Makoto M Hotta Daisuke D
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese 20220309
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Project description: Not available
| S-EPMC8114729 | biostudies-literature
Project description:BackgroundIatrogenic acute ascending aortic dissection during percutaneous coronary intervention (PCI) is an exceptionally rare and life-threatening sequel that requires early and accurate diagnosis along with rapid management. No guidelines have yet been established to direct decisions on the different treatment options that can be employed in the setting of acute aortic dissections caused by PCI. However, similar cases have been treated either by intracoronary stenting and conservative management as in localized aortocoronary dissections or by surgical intervention in cases of extensive aortic dissections.Case summaryHereby, we present a rare case of a female patient who developed "full-blown" acute ascending aortic dissection (Stanford type A-DeBakey type II dissection) with intramural hematoma during an elective percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) and left circumflex artery (LCA). Accordingly, emergent surgical repair of the dissected aorta was performed including grafting of supracoronary ascending aortic tube, along with coronary artery bypass graft placement and septal myomectomy for severely hypertrophied cardiac septum. The patient recovered successfully without any documented postoperative complications.ConclusionIt is pivotal to avoid aggressive use of instrumentation during PTCA in order to prevent the potential development of catheter-induced aortic dissection.
| S-EPMC5290308 | biostudies-literature
Project description:This is the case of a 40-year-old female diagnosed with NSTEMI. She underwent coronary angiography and suffered from type F left main coronary artery dissection. After hemodynamic stabilization, she was transferred to the nearest cardiothoracic surgery unit and underwent emergency coronary artery bypass graft (CABG) surgery. This report highlights important concepts in the management of a rare complication and emphasizes the surgical treatment decision-making, underlying an unusual but effective treatment approach.
| S-EPMC6007241 | biostudies-literature
Project description:BackgroundThe percutaneous treatment of heavily calcified coronary lesions is challenging and presents high rate of complications. Unexpandable stent is one of the most serious complication. Both of these conditions may benefit from the intracoronary lithotripsy (ICL-Shockwave®), a new coronary percutaneous technique.Case summaryThis case report describes a man treated with percutaneous coronary intervention (PCI) for a left main (LM) severe calcified lesion. The PCI was complicated by a huge dissection of LM in a not completely expandable lesion. A bail-out stent implantation was performed with residual unexpansion. The ICL permitted to expand acutely the stent and obtain an optimal final result.DiscussionFamiliarity with dedicated techniques and devices to treat calcified coronary lesions is fundamental to perform high-risk complex PCI. This case emphasizes the potential usefulness of the new ICL technique to treat calcified lesions or related complications like unexpandable stent.
| S-EPMC6939817 | biostudies-literature
Project description:We present a female patient with heart failure with reduced ejection fraction who underwent left bundle branch cardiac resynchronization therapy. Left bundle branch lead implantation was complicated with septal branch perforation causing an iatrogenic coronary fistula complicated by septal hematoma formation and development of shock. Occlusion by covered stents was successfully achieved.
| S-EPMC10774742 | biostudies-literature
Project description:Iatrogenic left main coronary artery and aortic root dissection is a rare but life-threatening complication of percutaneous coronary intervention. This is a case where this complication was induced by catheter manipulation. Prompt percutaneous closure of the dissection point of entry was effective in managing this complication. (Level of Difficulty: Advanced.).
| S-EPMC9175197 | biostudies-literature
Project description:BackgroundIatrogenic aortocoronary dissection (ACD) is a rare but potentially devastating complication of cardiac catheterization. We describe a case of an iatrogenic ACD following catheter engagement and balloon inflation of the proximal right coronary artery (RCA) during an elective percutaneous coronary intervention (PCI).Case summaryAn 81-year-old woman presented with an acute inferior wall ST-elevation myocardial infarction. Emergent coronary angiography revealed the three-vessel diseases. Primary PCI for the culprit lesion of the occluded mid-circumflex artery was successfully performed. After 10 days, an elective PCI for the residual RCA lesions was performed. After the balloon inflation of the proximal RCA, iatrogenic ACD was detected. Intravascular ultrasound-guided stent implantation sealing an entry tear prevented further dissection. The post-operative course was uneventful, and the patient was discharged 1 week later. Follow-up cardiac computed tomography revealed a disappearance of the aortocoronary intramural haematoma.DiscussionThis case emphasizes the importance of prompt detection and intervention for iatrogenic ACD. Heart team discussion is essential to determine whether cardiovascular surgery or percutaneous management should be performed. Bail-out stent implantation sealing an entry tear is frequently used and effective, and an intravascular ultrasound system would help to recognize the morphology of ACD, contributing to the safe procedure.
| S-EPMC10401319 | biostudies-literature
Project description:BackgroundWith the advances in medical technology and materials, thoracic endovascular aortic repair has become the mainstay of treatment for aortic dissection. In situ fenestration (ISF) and single-branch stent graft (SBSG) implantation are commonly used methods, with each having its own advantages and disadvantages. The study aimed to compare the perioperative outcomes and one-year follow-up results of patients who underwent ISF or SBSG in the treatment of acute Stanford type B aortic dissection involving the left subclavian artery (LSA).MethodsFrom January 2018 to December 2022, consecutive patients with Stanford type B aortic dissection were retrospectively recruited and divided into ISF group and SBSG group according to the type of surgery. The patient's aortic physiology was evaluated by computed tomography angiography at 1, 3, 6, and 12 months after discharge.ResultsThis study included 67 patients in the SBSG group and 21 patients in the ISF group. The baseline and preoperative indices were similar between the groups. The success rate of perioperative treatment was 100%, and no adverse consequences occurred in either group. No spinal cord ischemia, stroke, or paraplegia occurred in either group during the one-year follow-up. The rate of endoleak in the SBSG group was significantly lower (3%, all type I endoleaks) than that in the ISF group (9.5% type I and 14.3% type II endoleaks) (P=0.005). Type II endoleak mainly occurred in the LSA. In addition, complete thrombosis of the false lumen was achieved in 95.5% of the SBSG group versus 81.0% of the ISF group, but this was not a significant difference (P=0.091). The maximum diameter of the true lumen increased significantly in the ISF (P<0.001) and SBSG (P<0.001) groups. Meanwhile, the maximum diameter of the false lumen was significantly reduced in the ISF (P<0.001) and SBSG (P<0.001) groups, but the difference in the maximum diameter change of the true or false lumen between the two groups was not statistically significant (P>0.05).ConclusionsSBSG was associated with a significantly lower incidence of endoleak than was ISF. However, there were no differences observed in complete thrombosis of the false lumen. Further studies with larger sample sizes are needed to definitively establish which treatment is superior in terms of complete thrombosis of the false lumen.
| S-EPMC11400708 | biostudies-literature
Project description:BackgroundIatrogenic left main coronary artery dissection is a rare but serious complication that can occur both during diagnostic coronary angiography and percutaneous coronary intervention. Early diagnosis and choice of optimal management are of crucial importance for patient's outcome while representing a challenge for clinicians.Case presentationWe present a case of iatrogenic left main coronary artery dissection occurring during diagnostic coronary angiography in a 53-year-old Greek woman with a history of coronary artery bypass grafting. Although dissection was greatly extending to mid left anterior descending artery, delayed percutaneous coronary intervention was successfully performed by carefully wiring the true lumen.ConclusionsDelayed percutaneous coronary intervention, performed 25 days following the index event, proved to be a feasible and effective strategy for treating a widely extended left main coronary artery iatrogenic dissection.
| S-EPMC9743719 | biostudies-literature
Project description:Abstract Background Left main (LM) perforations necessitating a covered stent risk sacrificing the side branch. The lost side branch can be promptly recovered by fenestration of the covered stent, using a stiff wire. However, it is unclear whether subsequent balloon angioplasty of the recovered side branch ostium is sufficient to preserve side branch patency. We report the longer-term patency of the circumflex (LCx) ostium after LM covered stenting. Case summary A 78-year-old lady, with stable angina, presented for elective angiography. Percutaneous coronary intervention of the left anterior descending (LAD) artery to LM was complicated by a distal LM perforation. A covered stent across the LM sealed the perforation but resulted in acute occlusion of the LCx. The LCx was rescued by fenestration of the covered stent with a stiff wire, followed by balloon angioplasty to the LCx ostium. At follow-up, the angina had resolved. However, follow-up angiography demonstrated a new severe stenosis at the LCx ostium, with remnants of the polyurethane membrane seen protruding into the LCx ostium on optical coherence tomography. Therefore, the LCx ostium was stented, using the reverse Culotte technique. Conclusion This case demonstrates that stenting the LCx ostium should be considered after covered stent implantation from LM to LAD, because balloon angioplasty of the LCx ostium may not provide a durable result in this scenario.
| S-EPMC10473851 | biostudies-literature