Aortic dissection extending from the brachiocephalic artery during transradial coronary catheterization: a case report
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CASE REPORT
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Aortic dissection extending from the brachiocephalic artery during transradial coronary catheterization: a case report Kihyun Kim, Yeon Seong Kim, Yeongmin Woo and Sang-Yong Yoo*
Abstract Background: Iatrogenic acute aortic dissection (AD) is an extremely rare but devastating complication during cardiac catheterization. It can be treated conservatively if it develops in a retrograde form or manifests as an intramural hematoma (IMH) with a micro-intimal tear in the absence of instability. However, only a few reports exist on its natural course and long-term outcomes. Case presentation: A 78-year-old woman presented to the emergency department with acute chest discomfort. Elective cardiac catheterization was performed via the right radial artery. The patient’s brachiocephalic artery was so tortuous that the hydrophilic soft guidewire had to be exchanged for a stiffer one. However, the stiff wire caused the dissection of a tortuous brachiocephalic artery that extended from the sinuses of Valsalva to the proximal descending aorta. Emergent computed tomography showed crescentic aortic wall thickening without a dissection flap. The patient had cardiac tamponade and a gradually thickening thrombosed false lumen. Although the patient was unstable during the first 2 weeks, she was stabilized during hospital stay with only conservative treatment. Consequently, she has been well for over 5 years. Conclusions: Even though the patient showed ominous findings, a good prognosis was expected because the AD was mainly retrograde. Furthermore, the thrombosed false lumen mimicked an IMH on imaging. To the best of our knowledge, this is the first report of an extensive iatrogenic AD originating from the brachiocephalic artery during right transradial catheterization that was treated conservatively despite clinical instability. Keywords: Iatrogenic aortic dissection, Transradial catheterization, Brachiocephalic trunk, Conservative treatment, Case report
Background Acute iatrogenic aortic dissection (AD) is an extremely rare but potentially lethal complication during cardiac catheterization. Only a few studies have been conducted on its natural history and long-term outcomes. Previous case series have suggested that iatrogenic ADs extending > 40 mm above the ascending aorta should be treated surgically. However, recent studies have reported that
iatrogenic AD can be treated conservatively if it develops in a retrograde form or manifests as an intramural hematoma (IMH) with a micro-intimal tear. Here, we report an extremely rare case of an acute DeBakey Type I AD that occurred during right transradial cardiac catheterization. Despite hypotension and increasing IMH thickness, the patient was successfully treated without surgery.
* Correspondence: [email protected] Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do 25440, Republic of Korea
Case presentation A 78-year-old woman with a history of hypertension and api
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