Puymirat E, Barbey C, Chassaing S, Bar O, Blanchard D
Service de cardiologie interventionnelle, clinique Saint-Gatien, 8, place de Cathédrale, 37042 Tours, France.
Ann Cardiol Angeiol (Paris). 2010 Jun;59(3):168-71. doi: 10.1016/j.ancard.2009.05.001. Epub 2009 Jun 9.
Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. The options for treatment are dictated by patient stability, nature of dissection of the coronary vessel, ability to restore the coronary circulation and extent of aortic dissection. Usually localized aortic dissections have been managed conservatively or treated by sealing the entry with a coronary stent. Extensive dissections may require a surgical intervention. We report the case of a 52-year-old man with iatrogenic dissection of the right coronary artery ostium and extension of the dissection to the ascending aorta during intraluminal angioplasty of an obstructive lesion in the first portion of the right coronary artery. The patient was managed conservatively without stenting (failure stenting of the right coronary artery) and without surgery. Aortic dissection was monitored by means of transesophageal echocardiography. Serial computed tomography scans demonstrated spontaneous resolution of the dissection. The evolution of the patient was satisfactory. Causes, frequency and treatment procedures of this iatrogeny are discussed.
冠状动脉造影和经皮介入术后发生医源性升主动脉急性夹层分离较为罕见。治疗方案取决于患者的稳定性、冠状动脉血管夹层的性质、恢复冠状动脉循环的能力以及主动脉夹层的范围。通常,局限性主动脉夹层采用保守治疗或通过冠状动脉支架封闭入口进行治疗。广泛的夹层可能需要手术干预。我们报告了一例52岁男性患者,在右冠状动脉第一部分阻塞性病变腔内血管成形术期间发生医源性右冠状动脉开口夹层并延伸至升主动脉。该患者未进行支架置入(右冠状动脉支架置入失败)且未进行手术,采用保守治疗。通过经食管超声心动图监测主动脉夹层。系列计算机断层扫描显示夹层自发消退。患者病情演变令人满意。本文讨论了这种医源性情况的病因、发生率和治疗方法。