CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
AFRICA
e11
Case Report
Aortic dissection, a complication during successful
angioplasty of chronic total occlusion of the right
coronary artery, was treated conservatively
S CHUNLAI, PR STELLA, A BELKACEMI, P AGOSTONI
Abstract
Aortic dissection is an uncommon but potentially lethal
complication that can occur during the engagement of a
guiding catheter. We report a case of a 59-year-old woman
with acute aortic dissection due to percutaneous coronary
intervention. This resulted in a retrograde extension of the
dissection into the proximal part of the ascending aorta.With
haemodynamic stability, we decided to treat the aortic dissec-
tion medically. As a result, a complete resolution of the aortic
dissection was documented by coronary angiography and the
follow-up computed tomography scan.
Keywords:
aortic dissection, percutaneous coronary intervention
Submitted 15/6/11, accepted 6/9/11
Cardiovasc J Afr
2012;
23
: e11–e13
DOI: 10.5830/CVJA-2011-050
Dissection of the ascending aorta is a very rare iatrogenic
complication of percutaneous coronary intervention (PCI).
1
We
report here on a case of accidental aortic dissection that occurred
during PCI of a chronic total occlusion (CTO) lesion.
Case report
A 59-year-old woman with stable angina on limited effort was
admitted toour hospital for PCI of aCTOlesion, whichwas located
at the level of the mid-right coronary artery (RCA) after a previous
non-Q-wave acute myocardial infarction. Echocardiography
showed normal left ventricular systolic function without regional
wall-motion abnormalities. Her coronary risk factors were
hypertension, diabetes, hypercholesterolaemia, family history of
coronary artery disease and smoking.
On coronary angiography, the left main coronary artery and
left anterior descending coronary artery were normal. There
was 80% stenosis in the first obtuse marginal branch and
30% stenosis in the distal left circumflex coronary artery. The
mid-portion of the RCA was occluded, with poor collateral flow
to the distal RCA (Fig. 1).
After discussion with the cardiac surgeons, we decided on a
staged PCI; first a PCI of the RCA and then a PCI of the obtuse
marginal branch was planned. A 7 french Judkins JR4 guiding
catheter (Bosotn Scientific) was used in combination with a
0.014-inch Pilot 50 and Persuader 3 guide wire to cross the
occlusion of the RCA. After successful recanalisation with the
CTO wire, we changed to a normal floppy guide wire (Cougar,
Medtronic) and performed gradual pre-dilations with a 2.0
×
10-mm Sapphire, 3.0
×
15-mm Sapphire, 3.0
×
30-mm Pantera
and 3.50
×
15-mm XTRM Force balloon. Then we deployed
three Endeavor REsolute stents (2.5
×
24 mm/2.75
×
24 mm/3.0
×
30 mm) from the distal to mid-RCA. During placement of the
second stent, the guiding position was lost and re-inserted.
At the end of the procedure, we noticed an aortic dissection
in the proximal part of the ascending aorta (DeBakey type II,
Stanford type A) with good antegrade flow and no residual
stenosis in the RCA (Fig. 2). The patient reported slight transient
chest pain not associated with nausea, vomiting, shortness of
breath or palpitations. Her blood pressure was 120/75 mmHg
(equal on both arms) and the pulse 78 beats per minute.
Department of Cardiology, Second Affiliated Hospital of
Soochow University, SuZhou, China
S CHUNLAI, MD
Department of Cardiology, University Medical Center
Utrecht, Utrecht, the Netherlands
S CHUNLAI, MD,
PR STELLA, MD, PhD
A BELKACEMI, MD
P AGOSTONI, MD, PhD
Fig. 1. Coronary angiography showed the mid-portion of
the RCA occluded, with poor collateral flow to the distal
RCA.
