Frequency and outcomes of aortocoronary dissection during percutaneous coronary intervention of chronic total occlusions. Issue 4 (23rd December 2013)

• Record Type: Journal Article
• Authors: Shorrock, Deborah; Michael, Tesfaldet T.; Patel, Vishal; Kotsia, Anna; Rangan, Bavana V.; Abdullah, Shuaib A.; Grodin, Jerrold M.; Banerjee, Avantika; Brilakis, Emmanouil S.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 84:Issue 4(2014:Oct. 01)
• Page Start: 670
• Page End: 675
• Publication Date: 2013-12-23
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25338
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25338-sec-0001" sec-type="section"> <title>Background</title> <p>Aortocoronary dissection can complicate percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs).</p> </sec> <sec id="ccd25338-sec-0002" sec-type="section"> <title>Methods</title> <p>We retrospectively examined the frequency and outcomes of aortocoronary dissection among 336 consecutive CTO PCIs performed at our institution between 2005 and 2012 and performed a systematic review of the published literature.</p> </sec> <sec id="ccd25338-sec-0003" sec-type="section"> <title>Results</title> <p>Aortocoronary dissection occurred in six patients (1.8%, 95% confidence intervals 0.7%, 3.8%). All aortocoronary dissections occurred in the right coronary artery (CTO target vessel in five patients and donor vessel in one patient). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar. Compared to patients without, those with aortocoronary dissection were more likely to undergo crossing attempts using the retrograde approach (25% vs. 67%, <italic>P</italic> = 0.036) and experience a major complication (2.4% vs. 33.3%, <italic>P</italic> = 0.008). Technical and procedural success rates were similar in both groups. Of the six patients with aortocoronary dissection one underwent emergency coronary bypass graft surgery (CABG), four were treated with ostial stenting, and one was treated conservatively without subsequent adverse clinical outcomes. Systematic literature review provided 107 published cases of aortocoronary dissection during PCI, that occurred mainly in the right coronary artery (74.8%) and were treated with stenting (49.5%), emergency CABG (29%), or conservatively (21.5%).</p> </sec> <sec id="ccd25338-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Aortocoronary dissection is an infrequent complication of CTO PCI and although it can be treated with stents in most patients, it may infrequently require emergency CABG. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>