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Abstract

Background: Iatrogenic acute aortic dissection (AAD) is a rare but life-threatening complication of percutaneous coronary intervention (PCI), particularly in patients with predisposing risk factors such as hypertension. We present a case of extensive iatrogenic AAD managed with percutaneous coronary intervention.
Case: We present the case of a 55-year-old female with a history of uncontrolled hypertension, who presented to the emergency department with central chest heaviness and diaphoresis. Electrocardiogram (ECG) confirmed acute inferior wall myocardial infarction (IWMI). The patient was promptly treated with aspirin, ticagrelor, heparin, and nitrates before being shifted to the catheterization lab for primary PCI. A coronary angiogram revealed a non-obstructive left coronary artery and total occlusion of the right coronary artery (RCA) from mid-segment with a tortuous course.
PCI to distal RCA was performed with stent placement. Immediately after stent placement, an extensive Dunning type III aortic dissection involving the RCA was noted. The patient developed hemodynamic instability, requiring inotropic support and atropine for bradycardia. Immediately the longest available drug eluting stent was deployed from ostium of RCA to seal the entry point, followed by additional stenting in the mid segment of the RCA due to the propagation of the dissection distally. The aortic dissection did not propagate further, TIMI III flow was restored, and the patient regained hemodynamic stability. The patient was monitored in the cardiac intensive care unit, serial echocardiograms were done which did not show evidence of pericardial effusion or extension of aortic dissection. The patient was discharged in stable condition after three days. At three-month follow-up, the patient remained asymptomatic and compliant with medical therapy.
Conclusion: This case highlights the importance of recognizing and managing iatrogenic aortic dissection promptly in high-risk patients undergoing PCI.