CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
AFRICA
e13
0.1%.
2,3
The exact mechanism of aortic dissection caused by
PCI is unclear. Aortic dissections generally relate to retrograde
extension of a proximal dissection of a coronary artery.
Forceful manipulation of guide wires, vigorous injection of the
contrast medium, and accidental manipulation of the guiding
catheter have also been suggested to trigger coronary and aortic
dissections during PCI.
1
In this case, the aortic dissection may
have been caused by mechanical trauma caused by the tip of the
guiding catheter while re-inserting into the ostium of the RCA.
Acute dissections involving the ascending aorta (DeBakey type
I and II, Stanford type A) are considered surgical emergencies
requiring swift repair of the aortic root or reconstruction of the
ascending aorta and the arch to improve prognosis. By contrast,
dissections confined to the descending aorta (DeBakey type II,
Stanford type B) are treated medically unless progression of the
dissection, intractable pain, organ hypo-perfusion or extra-aortic
blood are demonstrated.
4
If a surgical strategy is selected, there is a high risk
of potentially life-threatening bleeding complications due
to aggressive anti-platelet treatment for these stent-treated
patients. With
β
-blockers, in combination with other anti-
hypertensives, blood pressure levels between 100 and 120
mmHg are achievable.
4
As this dissection remained localised to
the anterolateral portion of the ascending aorta, combined with
a stable haemodynamic status, a conservative, medical treatment
was chosen with strict blood pressure control in order to prevent
further extension.
Conclusion
Aortic dissection is an uncommon but potentially lethal
complication that can occur during PCI. Provided there is good
haemodynamic stability and no interference with other vessels
coming out of the ascending aorta, vigilant medical therapy, as
described in our case report, may be preferable to surgery.
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Yip HK, Wu CJ, Yeh KH,
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3.
Alfonso F, Almeria C, Fernandez-Ortiz A,
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Ince H, Nienaber CA. Diagnosis and management of patients with
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Fig. 5. After four weeks, aortic angiography showed that the dissection was absent in the proximal part of the aorta
(A), and the RCA was patent (B).
A
B
