Kahraman Fatih, Uzun Mehmet Hakan, Utku Ökkeş
Department of Cardiology, Kutahya Health Sciences University, Kutahya City Hospital, Kutahya, Turkey.
Cardiology Clinic, Kutahya City Hospital, Kutahya, Turkey.
JACC Case Rep. 2025 Jul 23;30(20):104212. doi: 10.1016/j.jaccas.2025.104212.
Iatrogenic aortic dissection (AD) is a rare but severe complication associated with coronary angiography and interventions. The primary cause of AD is the retrograde extension of coronary artery dissection. Guiding catheter-induced aortocoronary dissection can rapidly deteriorate a patient's hemodynamic status, particularly if the coronary artery was previously patent or if the AD extends >40 mm. In this report, we present a case involving a right coronary artery with chronic total occlusion that was dissected to the crux during guiding catheter engagement, with dissection retrogradely extending to the aorta. We successfully treated the chronic total occlusion lesion using a retrograde approach and addressed the intramural hematoma with a cutting balloon (Wolverine). The retrograde AD was managed conservatively with intensive care unit follow-up. The patient was discharged in good health. Prompt diagnosis and management of aortocoronary dissection are crucial to prevent adverse outcomes and improve survival rates.
医源性主动脉夹层（AD）是一种与冠状动脉造影及介入治疗相关的罕见但严重的并发症。AD的主要病因是冠状动脉夹层的逆行扩展。引导导管所致的主动脉冠状动脉夹层可迅速使患者的血流动力学状态恶化，尤其是在冠状动脉先前通畅或AD扩展超过40mm的情况下。在本报告中，我们呈现了一例病例，该病例涉及一支慢性完全闭塞的右冠状动脉，在引导导管置入过程中夹层扩展至心脏十字交叉处，并逆行扩展至主动脉。我们采用逆行方法成功治疗了慢性完全闭塞病变，并使用切割球囊（Wolverine）处理了壁内血肿。对逆行性AD采用重症监护病房随访的保守治疗方法。患者健康出院。及时诊断和处理主动脉冠状动脉夹层对于预防不良后果和提高生存率至关重要。
