Al-Omary Mohammed S, Albayati Ammar, Collins Nicholas J, Bellamy Greg, May Austin, Boyle Andrew J
John Hunter Hospital, Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
John Hunter Hospital, Newcastle, New South Wales, Australia.
JACC Case Rep. 2025 May 21;30(11):103326. doi: 10.1016/j.jaccas.2025.103326. Epub 2025 Apr 9.
Iatrogenic coronary artery dissection (ICAD) is an uncommon and serious complication of percutaneous coronary intervention (PCI), occurring in <1% of cases, potentially leading to abrupt vessel closure, myocardial infarction, or death.
We describe a case of ICAD managed successfully using retrograde PCI without visible collateral channels. The patient had an iatrogenic type D dissection of the right coronary artery, treated effectively with this innovative approach.
Retrograde PCI has been reported in cases with ICAD and visible septal collateral channels. However, this case demonstrates feasibility even in their absence, avoiding the need for surgical intervention. This case offers valuable insights into managing complex, life-threatening PCI complications and highlights the importance of procedural adaptability to ensure optimal outcomes.
TAKE-HOME MESSAGES: Gentle contrast injection and meticulous coronary wiring minimize ICAD risk. When it occurs, retrograde bailout stenting is a viable option if antegrade approaches fail, in the absence of visible collateral branches.
医源性冠状动脉夹层（ICAD）是经皮冠状动脉介入治疗（PCI）的一种罕见且严重的并发症，发生率低于1%，可能导致血管突然闭塞、心肌梗死或死亡。
我们描述了一例在无可见侧支循环的情况下通过逆行PCI成功治疗的ICAD病例。该患者为右冠状动脉医源性D型夹层，采用这种创新方法得到了有效治疗。
已有报道在伴有ICAD且有可见室间隔侧支循环的病例中采用逆行PCI。然而，本病例表明即使在没有侧支循环的情况下该方法也可行，避免了手术干预的需要。本病例为处理复杂的、危及生命的PCI并发症提供了有价值的见解，并强调了手术灵活性对于确保最佳结果的重要性。
轻柔注射造影剂和细致的冠状动脉导丝操作可将ICAD风险降至最低。当发生ICAD时，如果顺行方法失败且没有可见的侧支分支，逆行补救性支架置入是一种可行的选择。
