CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
e12
AFRICA
Since both haemodynamically and angiographically there
were no changes, even after 25 minutes, we decided to stop
the procedure and not bring the patient in for surgery. Cardiac
computed tomography (CT) revealed a type A dissection with
a predominantly intramural haematoma. The dissection did
not extend into the coronary arteries and cerebral vessels, but
stopped at the origin of the arteria brachiocefalica (Fig. 3).
Because of her haemodynamic stability, we decided to treat
the aortic dissection medically, so the patient was transferred
to the coronary care unit. Metoprolol tartrate 300 mg/day,
telmisartan 80 mg/day, amlodipine 5 mg/day, enteric-coated
aspirin 100 mg/day and clopidogrel 75 mg/day were given to the
patient. After five days, a follow-up CT showed a stable situation
with a considerable amount of sub-intimal haemorrhage at the
proximal part of aorta, with unchanged dimensions. A small
pericardial effusion was present with no evidence of tamponade
(Fig. 4).
The patient was discharged uneventfully and seen in the
cardiology outpatient clinic after 10 days. She had no complaints,
with stable systolic blood pressure between 100 and 110 mmHg.
Four weeks later, during the scheduled second procedure for
PCI of the right circumflex coronary artery, aortography showed
no sign of the dissection in the proximal part of the aorta, and a
well-maintained result of the RCA-CTO (Fig. 5).
Discussion
Aortic dissection is a rare complication after percutaneous
coronary intervention,
1
with a reported incidence of 0.03 to
Fig. 2. During injection of the right coronary artery, angiography showed Stanford type A (DeBakey type II) dissection
in the proximal part of the aorta (A), and good anterograde flow in the RCA (B).
A
B
Fig. 3. Computed tomographic scan revealed a type A
dissection with a predominantly intramural haematoma.
Fig. 4. Five days after the event, a computed tomographic
scan showed decreased echogenity with a consider-
able amount of sub-intimal haemorrhage at the proximal
part of the aorta. The thrombosed false lumen was not
expanding to arch.
