Department of Cardiology, St. Adalbert's Hospital in Gdansk, Copernicus PL, Gdansk, Poland.
Department of Cardiology, St. Vincent de Paul Hospital in Gdynia, Pomeranian Hospitals, Gdynia, Poland.
Cardiol J. 2024;31(3):398-408. doi: 10.5603/CJ.a2022.0050. Epub 2022 Jun 28.
Only the incidence, management, and prognosis of catheter-induced coronary artery and aortic dissections have been systematically studied until now. We sought to evaluate their mechanisms, risk factors, and propagation causes.
Electronic databases containing 76,104 procedures and complication registries from 2000-2020 were searched and relevant cineangiographic studies adjudicated.
Ninety-six dissections were identified. The overall incidence was 0.126%, and 0.021% for aortic injuries. The in-hospital mortality rate was 4.2%, and 6.25% for aortic dissections. Compared to the non-complicated population, patients with dissection were more often female (48% vs. 34%, p = 0.004), with a higher prevalence of comorbidities such as hypertension (56% vs. 25%, p < 0.001) or chronic kidney disease (10% vs. 4%, p = 0.002). They more frequently presented with acute myocardial infarction (72% vs. 43%, p < 0.001), underwent percutaneous coronary intervention (85% vs. 39%, p < 0.001), and were examined with a radial approach (77% vs. 65%, p = 0.011). The most prevalent predisposing factor was small ostium diameter and/or atheroma. Deep intubation for support, catheter malalignment, and vessel prodding were the most frequent precipitating factors. Of the three dissection mechanisms, 'wedged contrast injection' was the commonest (the exclusive mechanism of aortic dissections). The propagation rate was 30.2% and led to doubling of coronary occlusions and aortic extensions. The most frequent progression triggers were repeat injections and unchanged catheter. In 94% of cases, dissections were inflicted by high-volume operators, with ≥ 5-year experience in 84% of procedures. The annual dissection rate increased over a 21-year timespan.
Catheter-induced dissection rarely came unheralded and typically occurred during urgent interventions performed in high-risk patients by experienced operators.
目前，仅有导管相关冠状动脉和主动脉夹层的发病率、处理方法和预后得到了系统研究。我们试图评估其发生机制、危险因素和扩展原因。
检索了包含 2000 年至 2020 年 76104 例手术和并发症登记处的电子数据库，并对相关 cineangiographic 研究进行了裁决。
共发现 96 例夹层。总发生率为 0.126%，主动脉损伤发生率为 0.021%。住院死亡率为 4.2%，主动脉夹层死亡率为 6.25%。与非并发症患者相比，夹层患者女性更多（48%比 34%，p=0.004），合并症更常见，如高血压（56%比 25%，p<0.001）或慢性肾脏病（10%比 4%，p=0.002）。他们更常出现急性心肌梗死（72%比 43%，p<0.001），接受经皮冠状动脉介入治疗（85%比 39%，p<0.001），并采用桡动脉入路（77%比 65%，p=0.011）。最常见的诱发因素是小动脉口直径和/或动脉粥样硬化。深插管支持、导管错位和血管探查是最常见的诱发因素。在三种夹层机制中，“楔入对比注射”是最常见的（主动脉夹层的唯一机制）。传播率为 30.2%，导致冠状动脉闭塞和主动脉延伸加倍。最常见的进展触发因素是重复注射和导管不变。在 94%的病例中，夹层是由经验丰富的操作人员造成的，这些操作人员的年手术量≥5 年的占 84%。在 21 年的时间里，每年的夹层发生率都在增加。
导管相关的夹层很少是突发的，通常发生在高危患者的紧急介入治疗中，由经验丰富的操作人员进行。
