Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy.
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):E900-E910. doi: 10.1002/ccd.29367. Epub 2020 Nov 17.
Iatrogenic aorto-coronary dissection (ICD) is one of the most feared complications of interventional cardiology. Although rare, it is characterized by anterograde coronary ischemia and a concomitant aortic dissection, with potentially fatal consequences.
We present an example case of IACD and an accurate case-series review of the literature including 125 published cases.
There were no significant predisposing factors and the IACD occurred equally in elective and urgent procedures. A significant number of IACDs were associated with CTO procedures. The factors associated with a worse outcome were hemodynamic instability, the presence of anterograde ischemia, and the extent of dissection according to the Dunning classification. Bail-out stenting was the most used strategy and its failure was associated with mortality.
The main features of IACD are anterograde ischemia, retrograde dissection, and hemodynamic instability, each of them should be addressed with no time delay, possibly with bailout stenting, the most employed exit-strategy. According to our proposed algorithm, a shock team approach is required to coordinate the interdisciplinary skills and enabled patients to receive the best treatment.
医源性主动脉-冠状动脉夹层（ICD）是介入心脏病学中最可怕的并发症之一。虽然罕见，但它的特征是顺行性冠状动脉缺血和同时发生的主动脉夹层，可能导致致命后果。
我们展示了一个 ICD 病例，并对包括 125 例已发表病例在内的文献进行了准确的病例系列回顾。
没有明显的易患因素，ICD 在择期和紧急手术中发生率相等。相当数量的 ICD 与 CTO 手术有关。与不良预后相关的因素是血流动力学不稳定、存在顺行性缺血以及根据 Dunning 分类的夹层程度。紧急支架置入术是最常用的策略，其失败与死亡率相关。
ICD 的主要特征是顺行性缺血、逆行性夹层和血流动力学不稳定，应立即处理每一个特征，可能需要紧急支架置入术，这是最常用的治疗策略。根据我们提出的算法，需要采用休克团队方法来协调多学科技能，使患者能够接受最佳治疗。
